Objective: The aim of this study was to evaluate the effect of a recently developed biphasic multicomponent solvent in patients with pigment and/or mixed biliary duct stones that are too large to be removed after endoscopic sphincterotomy. Patients and design: From November 1991 to October 1992, 22 patients with bile duct stones (diameter > 10 mm) were papillotomized (20 out of 22) and a nasobiliary catheter was positioned above the stone (20 out of 22). In two patients, the residual stones were dissolved via a T-tube inserted during cholecystectomy (two out of 22). Solvent mixtures [solvent 1: 26 mmol/l EDTA, 40 mmol/l sodium deoxycholate and 30% dimethylsulfoxide (DMSO) in an aqueous glycine-NaOH buffer solution; solvent 2: a 70: 30 mixture of DMSO and methyl-tert-butyl ether] were infused continuously and alternately for 2 h at a rate of 0.3-0.5 ml/kg body weight per h. In order to diminish the absorption of the solvent from the duodenum, charcoal was given orally periodically. Results: Fluoroscopy indicated that the bile duct stones disappeared during 16 -24 h of infusion in nine out of the 22 patients. In 11 patients, the size of the stones diminished sufficiently for them to be removed by basket extraction. In two patients, the size of the stones did not change and surgery or endoscopic stenting was required. Only mild toxic side effects were observed, including laboratory abnormalities and moderate duodenitis (13 out of 22). Transient abdominal pain and/or cramp (14 out of 22), nausea and vomiting (15 out of 22) and diarrhoea (12 out of 22) were the most common complaints during treatment. Conclusions: Direct dissolution therapy with a biphasic multicomponent solvent seems to be an effective and alternative method for the non-surgical management of bile duct pigment and mixed stones.
|Number of pages||4|
|Journal||European Journal of Gastroenterology and Hepatology|
|Publication status||Published - Jan 1 1993|
- Bile duct stones
- Direct dissolution therapy
- Multicomponent solvent
ASJC Scopus subject areas