Gallstone dissolution is a nonsurgical method of treating gallstones, which is rarely used today.
There are 2 main methods of gallstone dissolution:
- Oral dissolution with bile acid tablets or
- Contact dissolution with direct instillation of a solvent into the gallbladder.
Gallstone dissolution is intended for individuals who have symptomatic gallstones but do not want or cannot have their gallbladders removed due to old age or severe underlying condition.
Oral Dissolution of Gallstones With Bile Acids
Individuals suitable for oral gallstone dissolution include those who have [5,6]:
- A single stone smaller than 20 mm made of cholesterol and no calcium (not visible on X-ray)
- Normal gallbladder function and no stones in the cystic duct
- Occasional, but not frequent, gallbladder attacks
Which bile acids are used?
Bile acids for oral dissolution of gallstones include ursodeoxycholic and chenodeoxycholic acid.
Ursodeoxycholic acid (ursodiol) inhibits the absorption of cholesterol in the intestine, which results in a decreased concentration of cholesterol in the bile and subsequent slow dissolution of cholesterol gallstones.
The usually prescribed dose of ursodiol is 8-10 mg/kg body weight/day; larger doses do not seem to be more effective .
The expected rate of dissolution is 1 mm decrease in stone diameter per month . The success of dissolution is monitored by ultrasound every 6 months.
Ursodiol can also be used to prevent :
- Gallstones in individuals with rapid weight loss, for example, after bariatric surgery
- Acute pancreatitis in individuals with gallbladder sludge
Ursodiol rarely has side effects, such as diarrhea, nausea, indigestion, abdominal pain, cough or hair loss .
Chenodeoxycholic acid (chenodiol) inhibits the synthesis of cholesterol in the liver. It is now rarely used due to common side effects, such as diarrhea, liver injury and the increase in blood cholesterol levels .
In one 2001 study, treatment with a combination of ursodiol and chenodiol gave similar results as the treatment with ursodiol alone .
Extracorporeal shock-wave lithotripsy (ESWL) can be used to break big gallstones into smaller ones before dissolution.
Reasons for the treatment failure:
- Impaired gallbladder contraction 
- Acquired stone calcification during the treatment 
After dissolution with bile acids, gallstones recur in 50% within 5 years and almost all treated individuals within the next 5-10 years . Recurrence is much higher after the dissolution of multiple stones .
Gallstones that do not dissolve significantly in the first 6 months will not likely dissolve by further treatment .
Contact Gallstone Dissolution
Contact gallstone dissolution refers to instillation of a solvent methyl tertiary-butyl ether (MTBE) or monooctanoin into the gallbladder. This can be done either via a catheter inserted through a puncture in the abdominal wall or via the nose, duodenum and bile ducts.
This method results in dissolution of most single or multiple cholesterol gallstones of any size within several hours or few days [5,6].
Contact dissolution may have side effects, such as nausea, pain and somnolence; more severe side effects, such as erosive duodenitis, hemolytic anemia or aspiration pneumonia, are rare [11,12]. The treatment is not approved by the U.S. Food and Drug Administration .
According to a couple of studies, gallstones recur in up to 70% individuals within 4 years of contact dissolution [9,10].
Natural Remedies and Supplements
There is NO EVIDENCE about the effectiveness of gallbladder (liver) flush, which includes a 12-hour fast followed by the ingestion of olive oil and lemon juice, in the treatment of gallstones .
Rowachol®, a mixture of terpene compounds, seems to be only mildly effective in the dissolving gallstones [14,15,16,17].
There is INSUFFICIENT EVIDENCE about the preventative effect of iron, soy lecithin, vitamin C, coffee, alcohol, fiber supplements or high calcium intake [17,18,19] or Chinese medicinal herbs  on the formation of gallstones [17,18,19].
In conclusion, currently, the only substances that are used today and can effectively dissolve gallstones are ursodiol for oral dissolution and MTBE for contact dissolution.
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- Contact Dissolution for Gallstones Aetna
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- Gan T et al, 2013, Chinese medicinal herbs for cholelithiasis Cochrane