[Lysis of gallstones with methyl tert-butyl ether: percutaneous transhepatic or transpapillary?].
Thirty patients (23 women, 7 men, mean age 53 [24-77] years) with symptomatic radiolucent gallbladder stones were treated by litholysis with methyl tert-butyl ether (MTBE), introduced through a catheter inserted into the gallbladder either by the percutaneous-transhepatic route (n = 19) or the transpapillary route (n = 11). Correct placing of the catheter was more frequently successful by the percutaneous-transhepatic route than the transpapillary one (90 vs 73%). The duration of lysis (median: 7 h and 8 h, respectively) and the proportion of stones which were completely dissolved immediately after lysis (53 vs 55%) were similar in both groups. Supplemented by subsequent oral therapy, the success rate at 6 months was higher in the percutaneous-transhepatic group (83 vs 64%), however, recurrences were more frequent. In the percutaneous-transhepatic group there was one case of gall-bladder leak and one catheter dislocation, and in the transpapillary group there was one case of pancreatitis, one of induction of ether anaesthesia and one pulmonary embolism. MTBE lysis is a relatively speedy and effective mode of non-operative therapy for gall-bladder stones. The percutaneous-transhepatic method is suitable for younger patients with a normal gall-bladder. The transpapillary procedure is preferable for older patients, and also when gall-bladder puncture proves difficult or when there is concurrent choledocholithiasis.
Medizinische Klinik I, Städtisches Krankenhaus Solingen.
U
U
Stabenow-Lohbauer
T
T
Bozkurt
M
M
Langer
G
G
Lux
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000628:therapy*; D003549:Cystic Duct; D004987:Ethers / Q000008:administration & dosage*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D012008:Recurrence; D012997:Solvents / Q000008:administration & dosage*; D013997:Time Factors
D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether
Lyse von Gallenblasensteinen mit Methyl-tert-butyl-ether: perkutan-transhepatisch oder transpapillär?