[Internist therapy of cholelithiasis].

Medical treatment of gallstones as an alternative to cholecystectomy has been established in recent years. Considering certain conditions--i.e. radiolucent cholesterol gallstones, functioning gallbladder, stone size, patients' cooperation--it is possible in up to 70% to dissolve gallstones completely or partially, using a therapeutic regimen of chenodeoxycholic or ursodeoxycholic acid at a dosage of 10 mg or 15 mg/kg body weight respectively. Side effects as diarrhoea or slight increase of serum transaminase levels are harmless and occur only with chenodeoxycholic acid. Therapeutic success may be controlled either by ultrasound or by cholecystography. Recurrence rate after dissolution is about 20%. Stones of the common bile duct can be treated easily by endoscopic papillotomy (EPT). In many cases the stone has to be removed with a basket; however, it may pass spontaneously. Certain indications for this procedure are obligatory. In the first place there is the patient over 50 years of age with the gallbladder already removed.