Gallstone dissolution in the biliary tract: in vitro investigations on inhibiting factors and special dissolution agents.

Investigations of four bile duct stones demonstrated that the distribution of organic compounds, pigments, and crystalline calcium salts as well as the stone architecture can prevent dissolution with perfusion therapy. We describe perfusion media that will dissolve or disaggregate the substances mentioned in vitro. Isolated organic compounds, probably mucoproteins, could be disaggregated with a SH-activated enzyme-containing bile salt-EDTA-solution (BA-EDTA) at pH 6.5-8.2. After admixture of 5-10% glyceryl-1-monooctanoin-carnosine to the BA-EDTA solution a mucoprotein-rich pigment concrement (calcium-bilirubinate stone) was completely disaggregated and the calcium and pigment portion was dissolved within 36 h. Alternating administration of an enzyme-free BA-EDTA solution with glyceryl-1-monooctanoin-carnosine resulted in accelerated dissolution of a pigment containing cholesterol stone compared to CApmul 8210. These perfusion media have been successfully used in patients. Factors limiting stone dissolution remain stone architecture, crystalline carbonic occlusions in high concentration, and the topography of the biliary tree.