Choledocholithiasis--in vivo stone dissolution using methyl tertiary butyl ether (MTBE).

Area of Science:

• Gastroenterology
• Hepatobiliary Medicine
• Interventional Radiology

Background:

• Large bile duct calculi often present challenges for standard endoscopic extraction.
• Elderly patients may have complex calculi refractory to conventional therapies.

Purpose of the Study:

• To evaluate the efficacy and safety of methyl tertiary butyl ether (MTBE) for gall stone dissolution in patients with large bile duct calculi.
• To assess MTBE as an alternative treatment for refractory bile duct stones.

Main Methods:

• A series of 10 elderly patients with large bile duct calculi were treated.
• Methyl tertiary butyl ether (MTBE) was instilled via a nasobiliary catheter for gall stone dissolution.
• Treatment duration and patient outcomes, including adverse reactions, were monitored.

Main Results:

• Complete bile duct clearance was achieved in 8 out of 10 patients.
• Successful dissolution occurred after an average of 8 hours of MTBE instillation.
• Two patients with low-cholesterol stones showed no change in size and required operative removal.
• Transient nausea and drowsiness were the only noted adverse effects.

Conclusions:

• Methyl tertiary butyl ether (MTBE) is a potent in vivo agent for dissolving bile duct stones.
• MTBE demonstrates a favorable safety profile with minimal toxicity in this patient cohort.
• MTBE offers a promising alternative for managing large, refractory bile duct calculi.