title: Percutaneous contact dissolution of gallstones: complexity of radiologic care.
abstract: 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.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston 02114.
authors.forename: P R
authors.initials: PR
authors.lastname: Mueller
authors.forename: M J
authors.initials: MJ
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Saini
authors.forename: J A
authors.initials: JA
authors.lastname: Brink
authors.forename: P F
authors.initials: PF
authors.lastname: Hahn
authors.forename: S L
authors.initials: SL
authors.lastname: Dawson
authors.forename: B
authors.initials: B
authors.lastname: Kammer
authors.forename: M C
authors.initials: MC
authors.lastname: Morrison
authors.forename: M
authors.initials: M
authors.lastname: Shortsleeve
authors.forename: J T
authors.initials: JT
authors.lastname: Ferrucci
mesh_terms: 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
chemical_list: D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether