ORAL AND CONTACT DISSOLUTION OF GALLSTONES

The appropriate selection of patients for treatment with oral ursodeox ycholic acid (UDCA) - a drug that has virtually no side effects - resu lts in about 50% of patients experiencing safe dissolution of gallston es within 2 years. Eligible patients have small (less than 20 mm in di ameter) radiolucent gallstones in a gallbladder visualized by oral cho lecystography (OCG); ideal candidates are thin women who have gallston es that are less than 15 mm in diameter, floating when observed by OCG , or of low density on computed tomographic (CT) scanning. Contact dis solution with methyl tert-butyl ether (MTBE) is rapid, effective more often than UDCA, and safe but requires the expertise of an interventio nal radiologist. Any size and number of cholesterol gallstones that ar e not CT-dense will be dissolved by MTBE, leaving at most only insolub le debris that is clinically innocuous. Although gallstones recur afte r dissolution by UDCA or MTBE in 50% of patients within 5 years, recur rent gallstones are usually asymptomatic and/or can probably be dissol ved. We conclude that oral or contact dissolution provides an alternat ive treatment to cholecystectomy for about 30% of patients with sympto matic gallstones.