Local Litholysis of Calcified Pigment Stones

Abstract

Therapeutic regimens in gallstone disease depend mainly on the composition of the stone. Most conservative approaches are restricted to cholesterol concrements. Systemic litholysis using chenodeoxycholic and ursodeoxycholic acids [1–3] and extracorporeal shock-wave lithotripsy (ESWL; [4, 5]) exhibit high success rates only in cases of small and (in ESWL) preferably single cholesterol stones. Local litholysis, which was performed initially in cholesterol stone disease with ether preparations [6], is the only non-operative therapy which can also be applied in pigment stone disease, provided the proper solvents are used. Furthermore, stone size and stone number do not play a role in the selection of patients for this form of treatment [7, 8]. In complicated gallstone disease, for example, cholecystitis and gallstone ileus, cholecystectomy has been the preferred form of therapy since its introduction in 1882 by Langenbuch [9]. An operative procedure must also be performed in end-stage gallstone disease, especially when the lack of a lumen in chronic cholecystitis prohibits percutaneous puncture. Cholecystectomy is also the procedure of choice in patients with a chronically inflamed, thickened gallbladder wall due the motility defect which would inevitably lead to stone recurrence after successful conservative treatment. A conservative approach in symptomatic but uncomplicated gallstone patients with calcified pigment gallbladder stones is lacking. The development of an alternate technique for local litholysis of this type of stone is demonstrated in this chapter.