The effect of monooctanoin on retained common duct stones.

Monooctanoin is a medium-chain diglyceride that is effective in dissolving cholesterol gallstones in vitro. The in vivo efficacy of monooctanoin was evaluated in eight patients who had monooctanoin infused through the T tube to dissolve retained common duct stones. Five of eight (62%) experienced success. Abdominal cramps and diarrhea were the only side effects, and these resolved by temporarily stopping the infusion or decreasing the rate of the infusion. Since bilirubinate stones accounted for the three failures, the composition of the stone is the determining factor in selecting a treatment plan for retained common duct stones. Retained cholesterol stones can be successfully treated within 4 to 7 days by T-tube infusion of monooctanoin. Pigment stones should be removed by extraction through the T-tube tract or by endoscopic papillotomy.