Methyl tert butyl ether dissolution therapy for common bile duct stones

Methyl tert butyl ether (MTBE) is a potent cholesterol solvent. We have used MTBE in twelve patients with 19 large radiolucent common bile duct stones which could not be removed endoscopically. MTBE was instilled directly into the common bile duct via a nasobiliary or percutaneous catheter. Successful clearance of the duct was achieved in ten patients. The stones disappeared completely in three patients with MTBE alone; in the remaining seven, it was possible to extract the stones endoscopically after MTBE, even though there was no change in the cholangiographic appearance. MTBE may have a role in the management of large retained common bile duct calculi but, given the practical difficulties of administration, its use should only be considered when other methods have failed and a non-surgical approach is desired.