[Oral and direct lysis of gallbladder calculi. Competing or complementary procedures to shockwave lithotripsy?]

Non-surgical treatment of cholesterol gallstones is possible with oral chemolitholysis employing chenodeoxycholic acid (CDA) and/or ursodeoxycholic acid (UDA), oral chemolitholysis following ESWL and direct dissolution with methyl tert-butyl ether (MTBE). Oral chemolitholysis takes a long time (6-24 months), is suitable only for small stones (up to 1.5 cm) and has a success rate of 60-70%. Prior ESWL shortens the duration of oral treatment moderately and can be employed with larger (up to 3 cm) stones; it is, however, quite expensive. The new method of direct chemolysis of gallstones is rapid, very cheap, and effective (approx. 95% success rate), but is an invasive procedure. If previous results obtained with MTBE are confirmed, it could become a therapeutic alternative to cholecystectomy in the case of very large and multiple stones.