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Dissolution of cholesterol gallbladder stones with methyl tert-butyl ether in patients with increased surgical risk
B E Eidsvoll1, E Aadland, M Stiris
1Dept. of Medicine, Aker University Hospital, Oslo, Norway.
Abstract:
The safety and efficacy of methyl tert-butyl ether (MTBE) dissolution of cholesterol gallbladder stones were evaluated in 25 patients with increased risk for surgery. Two patients were treated twice. The MTBE was infused and aspirated manually through a percutaneous transhepatic catheter to the gallbladder. The placement of the catheter failed in three patients (11%). In 19 of 24 patients (79%) there was complete dissolution of stones after a mean treatment time of 12.2 h (range, 4.3-19.5 h). In five patients treatment was discontinued before complete dissolution owing to technical problems or side effects. Side effects were nausea, pain, vasovagal reaction, and fever. Fifteen patients were followed up for a mean of 15.7 months after dissolution. Stone recurrence was found in eight patients, five of whom suffered symptomatic relapse. We conclude that dissolution therapy with MTBE is a safe and adequate alternative to surgery in selected high-risk patients.
Insights
Methyl tert-butyl ether (MTBE) dissolution safely and effectively dissolved cholesterol gallstones in most high-risk surgical patients. However, recurrence was observed in over half of patients during follow-up.
Area of Science:
- Gastroenterology
- Minimally Invasive Procedures
- Pharmacological Therapies
Background:
- Gallstone disease affects a significant portion of the population.
- Surgical intervention for gallstones carries inherent risks, particularly for high-risk patients.
- Alternative, less invasive treatments are sought for gallstone management.
Purpose of the Study:
- To evaluate the safety and efficacy of methyl tert-butyl ether (MTBE) for cholesterol gallstone dissolution.
- To assess MTBE dissolution as an alternative to surgery in patients with increased surgical risk.
Main Methods:
- MTBE was infused and aspirated manually via a percutaneous transhepatic catheter to the gallbladder in 25 high-risk patients.
- Catheter placement success rate and treatment duration were recorded.
- Efficacy was determined by complete stone dissolution, and safety was assessed by monitoring side effects.
- Patients were followed up for stone recurrence and symptomatic relapse.
Main Results:
- Catheter placement failed in 11% of patients.
- Complete gallstone dissolution was achieved in 79% of patients (19 out of 24) within a mean treatment time of 12.2 hours.
- Treatment was discontinued in five patients due to technical issues or side effects (nausea, pain, vasovagal reaction, fever).
- During a mean follow-up of 15.7 months, gallstone recurrence was observed in 8 patients, with 5 experiencing symptomatic relapse.
Conclusions:
- MTBE dissolution therapy is a safe and adequate alternative to surgery for selected high-risk patients with cholesterol gallstones.
- The procedure has a high success rate for dissolution but requires careful patient selection due to potential recurrence.
- Further research may be needed to address long-term recurrence rates and optimize treatment protocols.