Success of contact chemolysis in calcified cholesterol gallstones

Contact dissolution of cholesterol gallstones has emerged as a viable alternative in patients at high risk for surgery. The newest dissolution agent methyl tertiary butyl ether (MTBE) has undergone a series of successful clinical trials and has compared favorably with its predecessor, monooctanoin (MO). Previous studies have demonstrated the utility of MTBE in the setting of a large solitary gallstone impacted within the cystic duct as well as with multiple non-obstructing gallstones. We present a case of MTBE contact dissolution in the face of combined non-obstructing and obstructing gallbladder calculi. Whereas others have recommended restricting its use to those gallstones that are radiolucent, we have shown that MTBE may be used, and excellent results obtained, even with calculi that are calcified, so-called "Type 1" cholesterol gallstones.