Percutaneous contact dissolution of gallstones: complexity of radiologic care.
The clinical and technical considerations for successful gallstone dissolution with methyl tert-butyl ether (MTBE) are often underestimated. Patients are selected for MTBE therapy on the basis of a functioning gallbladder without evidence of acute inflammation or calcified stones at plain radiography. A transhepatic route is favored for percutaneous insertion of the cholecystostomy catheter because of the theoretic reduced frequency of bile leakage. MTBE is delivered manually through the catheter in a closed system, with dissolution times of 4-16 hours. After MTBE dissolution, residual debris in the gallbladder is present at follow-up sonography in up to 75% of patients. The high frequency of residual debris, the potential for stone recurrence, and the labor-intensive nature of MTBE therapy make its future uncertain, especially with the advent of laparoscopic cholecystectomy.
Mueller
P R
PR
Department of Radiology, Massachusetts General Hospital, Boston 02114.
Lee
M J
MJ
Saini
S
S
Brink
J A
JA
Hahn
P F
PF
Dawson
S L
SL
Kammer
B
B
Morrison
M C
MC
Shortsleeve
M
M
Ferrucci
J T
JT
D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004987:Ethers / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008738:Methyl Ethers; D015641:Radiography, Interventional; D012997:Solvents / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether