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Abstract

Since there are now several ways to treat symptomatic gallstone disease, one is able to select treatment on the basis of the patient's comfort, the practicability, effectiveness, and side effects of the technique, and the relative costs. In order to assess the present status of contact dissolution with methyl tert-butyl ether with regard to these aspects, the present enquiry reports the data of 21 European hospitals. Eight hundred three patients were selected for contact litholysis of cholesterol gallbladder stones using methyl tert-butyl ether. Percutaneous transhepatic puncture of the gallbladder was performed under x-ray or ultrasound guidance. Dissolution rate, side effects, and treatment times of 268 patients from one single center were compared to those of 535 patients from the other 20 centers. Two hundred sixty-four patients were followed for five years to assess stone recurrence. Physicians were asked how they assessed the expenditure of the method, the discomfort to the patients, and the staffing situation. Patients were asked to indicate their acceptance on an analog scale. Puncture was successful in 761 (94.8%) patients. Prophylactic administration of antibiotics was not necessary. Stones were dissolved in 724 (95.1%) patients. In 315 (43.5%) sludge remained in the gallbladder. The most severe complication was bile leakage, which led 12 (1.6%) patients to have elective cholecystectomy. Toxic injuries due to the ether were not reported. Method-related lethality amounted to 0%, 30-day-lethality to 0.4%. Stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over five years. Patients with multiple stones developed recurrent stones almost twice as often as those with solitary stones. The probability of stone recurrence in patients with sludge in the gallbladder after catheter removal was not statistically significantly different from those without sludge. Seventy to 90% of the centers found the puncture to be simple and not distressing for patients and the relation between expenditure and therapeutic success to be acceptable. The acceptance of contact litholysis by the patients was excellent. Contact litholysis when applied by an experienced team provides real advantages in the treatment of gallstone disease. The method is technically simple, well accepted by the patients, and can be easily applied in community hospitals. Contact litholysis may be of particular value in patients who are not suitable for anesthesia or surgery.

Efficacy and safety of a novel topical agent for gallstone dissolution: 2-methoxy-6-methylpyridine

“…Of these, MTBE is the only compound currently available. Although clinical studies have not reported critical toxicities of MTBE to date [4, 24, 25], several studies call into question the safety of MTBE. After administration, MTBE could be absorbed into the duodenum, leading to somnolence, nausea or vomiting [5–9, 11–14], it can also be systemically absorbed, resulting in hemolysis and reversible kidney injury [26].…”

“…The first concern is high incidence of stone recurrence. In a study of enrolling 803 patients with gallstones who had received contact litholysis using MTBE, stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over 5 years [4]. Another challenge is to obtain the minimally invasive way of introducing the solvent into gallbladder.…”

“…Unlike the lower boiling point of diethyl ether (35 °C), MTBE has a relatively higher boiling point (55 °C); thus, it is liquid at body temperature [2, 3]. Acceptable dissolubility of MTBE was validated by a variety of studies, including a large survey of 803 patients across 21 European hospitals that demonstrated a dissolution rate of 96.6% (724/804) with a low rate of toxic side effects and complications [4]. However, the widespread use of MTBE is limited by its side effects, such as nausea, upper abdominal pain, duodenitis, mild-to-moderate anesthesia, and hemolysis [5–14].…”

Use of Methyl Tert-Butyl Ether for the Treatment of Refractory Intrahepatic Biliary Strictures and Bile Casts: A Modern Perspective

“…Leuschner et al showed a dissolution rate of 96.6% in 120 patients with a low rate of complication and toxic side effects [ 14 ]. A larger survey in Europe of 803 patients from 21 institutions showed excellent dissolution rates with fewer side effects [ 11 ]. Common complaints included nausea, upper abdominal pain, duodenitis, and hemolysis [ 6 ].…”

“…Common complaints included nausea, upper abdominal pain, duodenitis, and hemolysis [ 6 ]. Without proper ventilation, the odor did cause light headedness and nausea from the staff in one study [ 6 ] yet the odor from the European survey showed no issues from patient or staff [ 11 ].…”