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Gallstone dissolution in vitro using methyl tert-butyl ether: radiologic selection criteria.
P E Nelson1, T P Moyer, J L Thistle
1Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
Gastroenterology
|May 1, 1990
Summary
Methyl tert-butyl ether effectively dissolves cholesterol gallstones. However, radiolucent stones are more likely to dissolve completely than radiopaque stones, which contain insoluble components.
Area of Science:
- Hepatobiliary Medicine
- Gastroenterology
- Medical Chemistry
Background:
- Gallstones are common, with cholesterol stones treatable by methyl tert-butyl ether (MTBE).
- Non-cholesterol components in gallstones limit MTBE dissolution and aspiration.
- Predicting MTBE efficacy requires understanding gallstone composition and characteristics.
Purpose of the Study:
- To evaluate MTBE's in vitro dissolution efficacy based on gallstone radiodensity and size.
- To identify gallstone characteristics predicting complete dissolution with MTBE.
- To guide patient selection for MTBE treatment of gallstones.
Main Methods:
- In vitro dissolution of gallstones using MTBE.
- Assessment of dissolution completeness based on gallstone radiodensity and size.
- Analysis of residual debris using infrared spectroscopy.
Main Results:
- Radiodensity significantly influenced dissolution completeness (p<0.01), while size did not (p>0.5).
- 81% of radiolucent gallstones dissolved completely, versus only 6% of radiopaque stones.
- Calcium bilirubinate and calcium carbonate were identified as insoluble components in radiopaque stones.
Conclusions:
- MTBE is most effective for radiolucent gallstones.
- Radiopaque gallstones contain insoluble calcium bilirubinate and calcium carbonate, limiting MTBE efficacy.
- Current MTBE treatment is best suited for patients with radiolucent gallstones.
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