Gallstone Dissolution – Gallstone Removal Without Surgery

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Published: December 4, 2017
Last reviewed: December 4, 2017

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 [6].

The expected rate of dissolution is 1 mm decrease in stone diameter per month [6]. The success of dissolution is monitored by ultrasound every 6 months.

Ursodiol can also be used to prevent [8]:

  • 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 [13].

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 [6].

In one 2001 study, treatment with a combination of ursodiol and chenodiol gave similar results as the treatment with ursodiol alone [4].

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 [2]
  • Acquired stone calcification during the treatment [2]

Prognosis

After dissolution with bile acids, gallstones recur in 50% within 5 years and almost all treated individuals within the next 5-10 years [3]. Recurrence is much higher after the dissolution of multiple stones [7].

Gallstones that do not dissolve significantly in the first 6 months will not likely dissolve by further treatment [6].

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 [11].

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 [17].

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 [20] 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.

  • References

      1. Hofmann AF, 1989, Medical dissolution of gallstones by oral bile acid therapy  PubMed
      2. Pereira SP et al, 1997, Gallstone dissolution with oral bile acid therapy. Importance of pretreatment CT scanning and reasons for nonresponse  PubMed
      3. Heumann DM, Gallstones (Cholelithiasis) Treatment & Management  Emedicine
      4. Petroni ML et al, 2001, Ursodeoxycholic acid alone or with chenodeoxycholic acid for dissolution of cholesterol gallstones: a randomized multicentre trial. The British-Italian Gallstone Study group  PubMed
      5. Schoenfield LJ et al, 1993, Oral and contact dissolution of gallstones  PubMed
      6. Guarino MPL et al, 2013, Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed  PubMed Central
      7. Villanova N et al, 1989, Gallstone recurrence after successful oral bile acid treatment. A 12-year follow-up study and evaluation of long-term postdissolution treatment  PubMed
      8. Ursodiol  MedlinePlus
      9. Thistle JL et al, 1989, Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter  PubMed
      10. Pauletzki J et al, 1995, Gallstone recurrence after direct contact dissolution with methyl tert-butyl ether  PubMed
      11. Contact Dissolution for Gallstones  Aetna
      12. Mueller PR et al, 1991, Percutaneous contact dissolution of gallstones: complexity of radiologic care  RSNA.org
      13. Ursodiol side effects  WebMD
      14. Leiss O et al, 1985, Effect of Rowachol on biliary lipid secretion and serum lipids in normal volunteers  PubMed Central
      15. Treatment of biliary duct stones with a terpene preparation  PubMed Central
      16. Bell CD et al, 1978, Rowachol, a proprietary terpene preparation solution dissolves gallstones Wiley Online Library
      17. Gaby AR, 2009, Nutritional approaches to prevention and treatment of gallstones  Alternative Medicine Review
      18. Walcher T et al, 2009, Vitamin C supplement use may protect against gallstones: an observational study on a randomly selected population  PubMed Central
      19. Njeze GE, 2013, Gallstones PubMed Central
      20. Gan T et al, 2013, Chinese medicinal herbs for cholelithiasis  Cochrane

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