Nonsurgical treatment of gallstone disease.

Gallstones can now be treated nonsurgically as well as surgically. The current view is that only symptomatic gallstones should be treated; of these, only cholesterol gallstones can be treated nonsurgically. Cholesterol gallstones in a functioning gallbladder will dissolve slowly when the secretion of unsaturated bile is induced by the ingestion of ursodiol or chenodiol, which are naturally occurring bile acids. Stone dissolution can be accelerated by increasing the surface area via extracorporeal shock wave lithotripsy, which fragments stones rapidly and safely, enhancing their dissolution rate. A technique is being developed in which a catheter is inserted into the gallbladder via either a percutaneous transhepatic or endoscopic route and an organic solvent such as methyl tert-butyl ether is instilled, dissolving the stones rapidly without major side effects. Gallstones will eventually recur in about half of the patients treated by these nonsurgical approaches, because the gallbladder is left in place and the fundamental pathogenic abnormalities associated with this common disease are not corrected. However, the rate of recurrence of symptomatic gallstone disease is lower.