title: [Contact litholysis of common bile duct calculi. Study of 44 patients].
abstract: OBJECTIVE
  Endoscopic sphincterotomy has become a generally accepted method for extracting common bile duct stones in high risk or cholecystectomized patients. However, stone extraction is impossible by the usual methods in 5 to 10% of cases. The purpose of this study was to evaluate the effect of a recently developed solvent system in patients with large bile duct stones.
  
  
  METHODS
  Forty four patients (15 men and 29 women, median age of years) underwent contact dissolution after unsuccessful Dormia extraction. Solvents were administered via a nasobiliary catheter in 41 patients following papillotomy and through a T-tube in 3 patients. Solvent mixtures (26 mM ethylene diamine tetraacetic acid, 40 mM sodium deoxycholate and 30% dimethyl sulfoxide in an alkaline aqueous solution; and a 70/30 dimethyl sulfoxide/methyl tert-butyl ether mixture) were infused continuously and alternatively for 2 hours.
  
  
  RESULTS
  Bile duct stones disappeared in 13-24 hours of infusion in 11 patients. In 29 patients, a clear reduction in stone volume occurred, allowing complete endoscopic extraction of the fragments. In 4 patients, the size of the stone did not change. Only mild and transient side-effects including abdominal pain (68%), nausea (72%), vomiting (52%), diarrhea and sleepiness (50%) were observed.
  
  
  CONCLUSIONS
  Direct dissolution therapy could be an effective method for the non-surgical management of large bile duct stones in selected patients when intra- or extracorporeal lithotripsy is unsuccessful.
authors.affiliation: Albert Szent-Györgyi Medical University, First Department of Medicine, Szeged, Hongrie.
authors.forename: T
authors.initials: T
authors.lastname: Takács
authors.forename: J
authors.initials: J
authors.lastname: Lonovics
authors.forename: F X
authors.initials: FX
authors.lastname: Caroli-Bosc
authors.forename: A M
authors.initials: AM
authors.lastname: Montet
authors.forename: J C
authors.initials: JC
authors.lastname: Montet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004492:Edetic Acid / Q000627:therapeutic use; D005260:Female; D042882:Gallstones / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000627:therapeutic use; D008875:Middle Aged; D012997:Solvents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D008738:Methyl Ethers; D012997:Solvents; C043243:methyl tert-butyl ether; D004492:Edetic Acid; D004121:Dimethyl Sulfoxide
vernacular_title: Litholyse de contact des calculs de la voie biliaire principale. Etude chez 44 malades.