FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 320:633-639 March 9, 1989 Number 10 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

We treated 75 patients with symptomatic cholesterol gallstones by dissolving the stones with methyl tert-butyl ether (MTBE) instilled into the gallbladder through a percutaneous transhepatic catheter. The MTBE was continuously infused and aspirated manually four to six times a minute, for an average of five hours per day for one to three days; the treatment was monitored by fluoroscopy. The placement of the catheter and the administration of MTBE caused few side effects or complications, and treatment did not have to be stopped in any patient for this reason. In 72 patients there was complete dissolution of stones or more than 95 percent dissolution. Among 21 patients who were completely free of stones after treatment, 4 had recurrence of stone formation 6 to 16 months later. The other 51 patients had residual debris, which spontaneously cleared completely in 15 patients within 6 to 35 months; only 7 with persisting debris have had symptoms. Five of the initial 6 patients treated, but only 1 of the next 69 patients, have required surgery during follow-up periods of 6 to 42 months. We conclude that the dissolution of gallstones by MTBE delivered through a percutaneous transhepatic catheter is a useful alternative to surgery in selected patients with symptomatic cholesterol stones. Further study will be necessary to establish the long-term effectiveness of this treatment and its appropriate role in the management of the various types of gallstones.

Source Information

Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minn. 55905.

This article has been cited by other articles:

• Johnston, D. E., Kaplan, M. M. (1993). Pathogenesis and Treatment of Gallstones. NEJM 328: 412-421 [Full Text]  
• Angle, C. R. (1991). If the Tap Water Smells Foul, Think MTBE. JAMA 266: 2985-2986 [Abstract]  
• Robinson, M., Bruner, R.H., Olson, G.R. (1990). Fourteen-and Ninety-Day Oral Toxicity Studies of Methyl Tertiary-Butyl Ether in Sprague-Dawley Rats. International Journal of Toxicology 9: 525-540 [Abstract]  
• Albert, M. B., Fromm, H., Borstelmann, R., Shehan, C. M., Gicking, R. (1990). Successful Outpatient Treatment of Gallstones with Piezoelectric Lithotripsy. ANN INTERN MED 113: 164-166 [Abstract]  
• Bruckstein, A. H. (1990). Nonsurgical Management of Cholelithiasis. Arch Intern Med 150: 960-964 [Abstract]  
• (1989). TREATMENT OF GALLSTONES WITH ETHER: IMPRESSIVE NEW DATA. JWatch General 1989: 3-3 [Full Text]