Gallstone dissolution in methyl tert-butyl ether after mechanical fragmentation: in vitro study

Area of Science:

• Gastroenterology
• Surgical Technology
• Biochemistry

Background:

• Gallstones are common, and current treatments like cholecystectomy have risks.
• Chemolysis using methyl tert-butyl ether (MTBE) is an alternative but can be slow.
• Improving dissolution rates for gallstone chemolysis is a clinical need.

Purpose of the Study:

• To evaluate the efficacy of intracorporeal mechanical fragmentation in accelerating gallstone dissolution with MTBE.
• To determine if stone calcification affects the benefit of mechanical fragmentation.

Main Methods:

• Human gallstones were matched and divided into three groups: fragmented then treated with MTBE, intact control treated with MTBE, and analyzed for density and composition.
• Gallstones were classified as noncalcified, partially calcified, or heavily calcified using CT scans.
• Dissolution times were compared between fragmented and intact stones.

Main Results:

• Mechanical fragmentation significantly reduced MTBE dissolution time by 25-69% for noncalcified and 20-42% for partially calcified gallstones.
• No significant reduction in dissolution time was observed for heavily calcified gallstones.
• The reduction in dissolution time was inversely correlated with maximal stone density (r = -0.72).

Conclusions:

• Intracorporeal mechanical fragmentation enhances gallstone chemolysis with MTBE for noncalcified and partially calcified stones.
• Heavily calcified gallstones do not benefit from mechanical fragmentation prior to MTBE treatment.
• Stone density, rather than calcification pattern, is the key factor determining the effectiveness of fragmentation in accelerating gallstone dissolution.