[The percutaneous dissolution treatment of gallstones. Our initial experience].
OBJECTIVE
To describe our initial experience in direct contact dissolution of cholesterol gallstones with methyl-tert-butyl ether, a non surgical approach for high risk patients.


METHODS
Twenty symptomatic patients were preselected. They all had radiolucent stones in functioning gallbladders. Patients rejected elective surgery or were considered to be of high risk for anesthesia. Computerized tomography scan was performed to evaluate stone calcium content and liver-gallbladder anatomy. In selected patients, contact stone dissolution was carried out after transhepatic gallbladder catheterization.


RESULTS
Ten patients were excluded due to poor gallbladder contact to the liver (two patients) or stone density greater than 70 Hounsfield Units. Percutaneous transhepatic positioning of the catheter into the gallbladder was achieved in seven patients. Stone dissolution was complete in five patients and partial in one. Mean perfusion time was 6.15 hours (3.45-7.5); however, mean hospitalization stay was 7 days (4-10) mainly due to inexperienced management coordination. While on treatment, all patients experienced nausea, burning or abdominal discomfort that were easily controlled. Complications were related to catheter placement (intraperitoneal biliary leakage, external fistula) and in five patients to the dissolution procedure (severe abdominal pain, biliary colic, cholecystopancreatitis). Complications were all handled with non surgical treatment.


CONCLUSIONS
Percutaneous gallstone dissolution with methyl-tert-butyl ether is a rapid and efficacious procedure that can, nevertheless, induce relevant secondary effects and complications.
Vilaseca
J
J
Hospital General Universitario Vall d'Hebrón, Barcelona.
Molero
X
X
Rius
J M
JM
Segarra
A
A
Alvarez Castells
A
A
Sureda
D G
DG
Andreu
J
J
Malagelada
J R
JR
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002765:Cholecystography; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D004341:Drug Evaluation; D004987:Ethers / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects / Q000379:methods; D012997:Solvents / Q000008:administration & dosage / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
D004987:Ethers; D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether
Tratamiento disolutivo percutáneo de la litiasis vesicular. Experiencia inicial.