[New possibilities in the management of gallbladder calculi].

The new nonsurgical methods of treating gallstone disease in gallbladder rely on fragmentation with extracorporeal shock wave lithotripsy (ESWL) and on dissolution of stones with ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA). Fragmentation alone is usually insufficient for gallbladder stones, and dissolution is only possible for cholesterol stones. Although oral dissolution with or without ESWL is an attractive alternative of surgery, only 25 percent of the patients are candidates for this therapy. Dissolution of the gallbladder stones by topical application of methyl-tertbutyl ether (MTBE) is an other option whose safety is still open to question. Therefore, cholecystectomy will remain the principal treatment for symptomatic gallbladder stones.