Frontiers of gallstone therapy. How far have we come with nonsurgical methods?

In the next few years, much will be learned about nonsurgical treatment of gallstones, and the role of each method will be more clearly defined. At present, each used alone has limitations (table 1). Oral chemolysis can be used for any number of gallstones, but only about 20% of patients are candidates for this method. Complete dissolution of stones can take months to years. Direct-contact dissolution therapy is rapidly effective, is inexpensive, and can be used for any size and number of gallstones. However, it is invasive, and only about 20% of patients are suitable candidates. Extracorporeal shock wave lithotripsy is noninvasive and avoids the complications and long recovery period of surgery. Up to three stones can be treated, but patients with certain medical conditions are excluded. About 20% to 30% of patients can undergo this treatment. None of these nonsurgical treatments prevents recurrence. Shock wave lithotripsy and dissolution with methyl tert-butyl ether are still in the experimental stage, so results of further study--particularly of combinations of the methods--are eagerly awaited by persons who have had symptomatic gallstones.