title: [MTBE litholysis and extracorporeal shock wave lithotripsy of gallstones].
abstract: Two new therapies for cholesterol gallstones, MTBE litholysis and extracorporeal shock-wave lithotripsy, have been developed and clinically tested in the last five years. In principle MTBE litholysis is applicable in 50-80% of gallstone patients and shock-wave lithotripsy in 25-30%. In MTBE litholysis a pigtail catheter is placed in the gallbladder by the percutaneous-transhepatic route using ultrasound-guidance. The gallstones can than be dissolved with the cholesterol contact solvent MTBE (methyl tert-butyl ether). With appropriate selection criteria the successful dissolution rate is 80-90%. Over 99% of radiolucent gallstones (1-3 stones per gallbladder) can be fragmented by extracorporeal shockwaves. Bile acids must be administered as adjuvant litholytic therapy, and thus the remaining fragments can be dissolved in 91% of cases within 2-18 months. In view of the limited experience with these procedures at the present time they are mainly indicated for symptomatic surgical high-risk patients and for those who strongly wish to avoid surgery. With careful evaluation of study data a broader indication policy may be possible in the future. The new methods and the essential study data are presented.
mesh_terms: D002769:Cholelithiasis / Q000188:drug therapy / Q000628:therapy*; D004987:Ethers / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008738:Methyl Ethers; D011677:Punctures / Q000379:methods; D012997:Solvents / Q000627:therapeutic use*; D007507:Therapeutic Irrigation / Q000379:methods
chemical_list: D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether
vernacular_title: MTBE-Litholyse und extrakorporelle Stosswellenlithotripsie von Gallenblasensteinen.