NONSURGICAL APPROACHES TO STONES IN THE BILIARY TREE

Medical treatment of cholesterol gall stones aims to dissolve the ston es leaving the biliary tract stone-free and the gall bladder in situ. The introduction of extracorporeal shock wave lithotripsy and contact solvent therapy with methyl tert butyl ether have revolutionised the m edical management of both gall bladder stones and bile duct stones whi ch are too large to be treated by sphincterotomy. Both approaches repr esent a major advance over cheno- and ursodeoxycholic acid which are e ffective in less than 30% of cases and require prolonged therapy. All medical treatments require a functioning gall bladder and suffer from relapse rates in the order of 10% per annum. Secondary prophylaxis is expensive and the rate of compliance and long term safety have yet to be established.