[Oral dissolving treatment of gallbladder calculi: focus in 1989]

Oral dissolution treatment with chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) is indicated in the case of cholesterol gallstones. However, three conditions must be satisfied for treatment to be effective: 1) the stones must be radiolucent; 2) the gallbladder must be functioning, i.e. opacified by oral cholecystography; 3) the stones must be smaller than 15 mm in diameter. Most authors consider that treatment is only justified when the stones are symptomatic. On the basis of these criteria, it has been estimated that about 20% of patients with gallstones presenting to gastroenterologists could be suitable for treatment. The mean percentage of efficacy is of the order of 50 to 60% at 18 months to 2 years. This percentage may be as high as 70-80% in the case of floating stones smaller than 1 cm. At the optimal dose (15 mg/kg/day), CDCA may induce diarrhoea and raised transaminases. Its prolonged administration can induce hepatic lesions. UDCA (7-10 mg/kg/day) generally does not have any side effect. The combination of CDCA/UDCA at the dose of 7-8 mg/kg/day of each agent may be more effective. After stopping treatment, a recurrence is observed in about 50% of cases within 5 years. Regular ultrasonographic follow-up (annually, for example) is therefore necessary to treat recurrences in time. Because of the criteria of efficacy and its adverse effects, oral dissolution treatment is only indicated in a very limited number of patients. However, it constitutes an essential complement to extracorporeal lithotripsy, which may represent its principal indication at the present time.