Methyl tert-butyl ether improves the efficacy of extracorporeal shock wave lithotripsy of human gallstones implanted in pigs.
OBJECTIVE
To investigate the contribution of contact dissolution with methyl tert-butyl ether (MTBE) to the success of extracorporeal shock wave lithotripsy (ESWL) of human gallstones implanted in pigs.


METHODS
Experimental study of matched pairs.


METHODS
Laboratory for experimental surgery, The Netherlands.


METHODS
30 pigs.


METHODS
Couples of similar human gallstones were surgically implanted into the gallbladders of 30 pigs. All pigs underwent ESWL with an electromagnetic lithotriptor. Half the animals were given adjuvant treatment with MTBE for 2 hours immediately after the ESWL. All pigs were killed a week after treatment.


RESULTS
Adjuvant MTBE dissolution led to superimposed damage of the gallbladder. One pig died of biliary leakage and peritonitis. For all kinds of stones, adjuvant MTBE treatment increased the median (range) percentage of stone dissolved by ESWL from 31 (0-58) to 60 (11-81) (p < 0.01), whereas for pure cholesterol stones the increase was from 23 (0-58) to 61 (11-81) (p < 0.01).


CONCLUSIONS
These data warrant clinical evaluation of the applicability of combined ESWL and MTBE dissolution of symptomatic gallstones in selected patients.
Vergunst
H
H
Department of Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Brakel
K
K
Nijs
H G
HG
Laméris
J S
JS
Ten Kate
F J
FJ
Schröder
F H
FH
Terpstra
O T
OT
D000818:Animals; D002769:Cholelithiasis / Q000628:therapy*; D002784:Cholesterol; D003131:Combined Modality Therapy; D003135:Common Bile Duct / Q000187:drug effects / Q000473:pathology; D004386:Duodenum / Q000187:drug effects / Q000473:pathology; D004987:Ethers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005704:Gallbladder / Q000187:drug effects / Q000473:pathology; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects; D008099:Liver / Q000473:pathology; D008738:Methyl Ethers; D010179:Pancreas / Q000187:drug effects / Q000473:pathology; D010538:Peritonitis / Q000209:etiology; D011693:Purpura / Q000209:etiology / Q000473:pathology; D012995:Solubility; D012997:Solvents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013552:Swine; D013927:Thrombosis / Q000209:etiology / Q000473:pathology
D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether; D002784:Cholesterol