DIRECT DISSOLUTION OF GALLSTONES WITH METHYL TERT-BUTYL ETHER BY ENDOSCOPIC CANNULATION OF THE GALLBLADDER

Methyl tert-butyl ether (MTBE) rapidly and effectively dissolves chole sterol gallbladder stones. Due to the invasive nature of transhepatic catheterization, we studied the safety and efficacy of MTBE stone diss olution, delivered by endoscopic, retrograde cannulation of the gallbl adder. Extracorporeal shock-wave lithotripsy (ESWL) was employed in pa tients with multiple stones, to increase contact surface area and faci litate dissolution. We successfully cannulated the gallbladder in 13/1 7 patients (76.5%) attempted, with no associated complications. After cannulation, MTBE lysis was then conducted on all patients, and 10/13 patients (77%) cannulated were either stone-free at completion, or had only residual gallbladder sludge. Predissolution ESWL successfully fr agmented stones in 6/7 patients (86%) in which it was attempted. Both ESWL and MTBE were well tolerated by all patients. Endoscopic retrogra de cannulation of the gallbladder and MTBE dissolution is a promising alternative for the treatment of gallbladder stones in patients who wi ll not receive surgery.