ESWL and Gallstone Dissolution with MTBE via a Naso-Vesicular Catheter

Abstract

Endoscopic placement of a naso-vesicular catheter was successful in 90% (45/50) of patients with cholecystolithiasis. The first 7 patients were treated by MTBE dissolution alone. Dissolution was discontinued after a maximum of 14 days, as only two patients were rendered stone free. In one patient, 3 tiny pigment stones were sucked out through the catheter, and in another inoperable patient a pigtail endoprosthesis was finally inserted into the gallbladder. In the remaining 36 patients, combined ESWL and MTBE dissolution therapy was carried out. Treatment was broken off by one patient after one week, and interrupted in another due to catheter dislodgement. After an average of 10 days with 1-9 ESWL sessions (average: 3) complete stone clearance was achieved in 60% (20/34) of patients. Fourteen of the patients who completed treatment, and the one with catheter dislodgement still have sludge in the gallbladder, which is being treated with oral bile acids. The procedure-related complication rate was 10% (3 pancreatitis, 1 cystic duct perforation and 1 guidewire impaction). The mortality rate was zero. There was no evident complication due to either ESWL or MTBE dissolution.

Endoscopic Retrograde Cholangiopancreatography Treatment of Cholecystitis: Possible? Yes; Practical??

“…Nasobiliary drains have been left in the gallbladder to perfuse agents to dissolve stones. (Stabenow-Lonbauer et al, 1991;Soehendra et al, 1990). One complication has been reported using a standard guidewire to access the gallbladder, but none have occurred using the new hydrophilic wires (Soehendra et al, 1990).…”

“…(Stabenow-Lonbauer et al, 1991;Soehendra et al, 1990). One complication has been reported using a standard guidewire to access the gallbladder, but none have occurred using the new hydrophilic wires (Soehendra et al, 1990). Although endoscopic access to the cystic duct and gallbladder is possible, such a maneuver must still be considered an experimental form of therapy.…”

Endoscopic Management of Gallbladder Stones: Can We Eliminate Cholecystectomy?

“…In 1984, transpapillary cannulation of the cystic duct was first described by Kozarek [11]. Endoscopic transpapillary cannulation of the gall bladder and attempts of gall stones dissolution either by mechanical or chemical means was first attempted in 1990 [12,13]. Soon This article is part of the Topical Collection on Pancreas / Biliary Tract after, transpapillary naso-cholecystic drainage for cholecystitis was reported [14].…”

Black Bile of Melancholy or Gallstones of Biliary Colics: Historical Perspectives on Cholelithiasis

“…The idea resurfaced when advances in endoscopic or radiologic techniques allowed direct access to the gallbladder with trans-sphincteric or transhepatic catheters. The direct infusion of methyl tert-butyl ether indeed led to successful dissolution of gallstones, but came with a significant complication risk [66][67][68]. Right around the same time, extracorporeal shock wave lithotripsy showed some promise in select individuals with isolated, non-calcified gallstones [69].…”