Abstract
Methyltert-butyl ether is an effective dissolution agent for cholesterol stones. The aim of this work was to evaluate the effect of methyltert-butyl ether on radiolucent common bile duct stones in patients in whom endoscopic extraction has failed. From September 1985 to September 1987, 1374 patients underwent endoscopic retrograde cholangiopancreatography in our Liver Unit. An endoscopic sphincterotomy was indicated in 195 patients with common bile duct (CBD) stones because of an age over 65 years and/or surgical contraindications. Endoscopic sphincterotomy was efficient in 187 patients, allowing complete stone removal in association with conventional endoscopic methods and mechanical lithotripsy in 170 patients. Twelve of the 17 patients with failure of conventional endoscopic treatments were either older than 75 years (11 patients; mean age, 86±4.5 years) or exhibited a surgical contraindication. Stones completely obstructed CBD in six patients and had a diameter exceeding 25 mm in the six other patients. These subjects were selected for stone dissolution by methyltert-butyl either (MTBE) according to the following protocol. MTBE was directly infused into CBD through a nasobiliary catheter, twice daily for 4–13 days (mean, seven days). Bile duct opacification, repeated after MTBE treatment, revealed the complete disappearance of CBD stones in one patient, a decrease in stone size in five patients and no change in the six tther patients. MTBE treatment was well tolerated except in three patients who complained from transient abdominal pains and nausea. At the second attempt of endoscopic treatment, CBD stones were found to be softened and easily broken up, allowing a complete clearance in six patients. MTBE treatment failed to improve stone extraction in the five other patients. These results show that, in patients with large radiolucent stones in the CBD, unextractable by conventional endoscopic methods, the direct infusion of MTBE in CBD rarely led to a complete stone dissolution; however, this treatment partially solubilizes stones, enabling their complete endoscopic extraction thereafter in half the patients.
Similar content being viewed by others
References
McSherry CK, Glenn F: The incidence and cause of death following surgery for nonmalignant biliary tract disease. Ann Surg 191:271–275, 1980
Sheridan WG, Williams HOL, Lewis MH: Morbidity and mortality of common bile duct exploration. Br J Surg 74:1095–1099, 1987
Ceese T, Neoptolemos JP, Baker AR, Carr-Locke DL: Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg 73:988–992, 1986
Classen M: Endoscopic papillotomy. New indications, short and long term results. Clin Gastroenterol 152:457–469, 1986
Way LW, Admirand WH, Dunphy JE: Management of choledocolithiasis. Ann Surg 176:347–359, 1972
Thistle JL, Carlson GL, Hofmann AF, La Russo NF: Effective dissolution of biliary duct stones by introductal infusion of monoactoine. Gastroenterology 74:1103, 1978
Palmer KR, Hofmann AF: Intraductal monoactoin for the direct dissolution of bile duct stones: Experience in 343 patients. Gut 27:196–202, 1986
Allan MJ, Borody JJ, Thistle JK:In vitro dissolution of cholesterol gallstones. Gastroenterology 89:1097–1103, 1985
Allan MJ, Borody TJ, Bugliosi TF, May GR, La Russo NF, Thistle JL: Rapid dissolution of gallstones by methyltert-butyl ether. N Engl J Med 312:217–220, 1985
Cotton PB: Endoscopic management of bile duct stonesapples and oranges. Gut 25:587–597, 1984
Thistle JL, May GR, Bender CE, Williams HJ, Leroy AJ, Nelson PE, Peine GJ, Petersen GT, McCullough JE: Dissolution of cholesterol gallbladder stones by methyltert-butyl ether administered by percutaneous transhepatic catheter. N Engl J. Med 320:633–639, 1989
Bonard L, Gandini G, Gadasio S, Fascetti E, Gremo L, Righi D, Asnaghi R, Volterrani U, Verme G: Methyltert-butyl ether and endoscopic sphincterotomy. A possible solution for dissolving gallstones. Endoscopy 18:238–239, 1986
Teplick SK, Haskin PH, Goldstein R, Corvasce JM, Frank EB, Sammon JK, Hofman AF: Case report-common bile duct stone dissolution with methyltert-butyl etherexperience with 3 patients. AJR 148:372–374, 1987
Padova CD, Padova FD, Montorsi W, Tritapepe R: Methyltert-butyl ether fails to dissolve retained radiolucent common bile duct stones. Gastroenterology 91:1296–1300, 1986
Murray WR, Laferla G, Fullarton GM: Choledocolithiasis,in vivo stone dissolution using methyltert-butyl ether. Gut 29:143–145, 1988
Thistle JL: Monoactoin in the dissolution of gallstones in bile ducts: Limitations and precautions. Hepatology 7:192–194, 1987
Dai KY, Montet JC, Zhao XM, Amic J, Choux R: Dissolving agents of human mixed cholesterol stones. Gastroenterol Clin Biol 12:312–319, 1988
Cains SR, Dias C, Cotton PB, Salmon PR, Russel RCG: Additional endoscopic procedures instead of urgent surgery for retained common bile duct stones. Gut 30:535–540, 1989
Ponchon T, Baroud J, Pujol B, Valette PJ, Perrot D: Renal failure during dissolution of gallstones by methyltert-butyl ether. Lancet 2:276–277, 1988
Tritapepe R, Pozzi C, Caspani P, Di Padova C: Unexpected dilation of the common bile duct after methyltert-butyl ether in rabbits. Possible implications to findings in man. Gut 30:206–212, 1989
Cotton PB, Forbes A, Leung JWC, Dineen L: Endoscopic stenting for long-term treatment of large bile duct stones: 2 to 5 year follow-up. Gastrointest Endosc 33:411–412, 1987
Demling L, Ermert H, Reimann JF, Schmocke J, Heyder M: Lithotripsy in the common bile duct using ultrasound. Endoscopy 15:226, 1984
Saverbruch T, Delius M, Paumgartner G, Holl J, Wess O, Weber W, Hepp W, Brendel W: Fragmentation of gallstones by extra corporeal shock waves. N Engl J Med 314:818–822, 1986
Ell CH, Lux G, Hochberger J, Muller D, Demling L: Laser lithotripsy of common bile duct stones. Gut 29:746–751, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Diaz, D., Bories, P., Ampelas, M. et al. Methyltert-butyl ether in the endoscopic treatment of common bile duct radiolucent stones in elderly patients with nasobiliary tube. Digest Dis Sci 37, 97–100 (1992). https://doi.org/10.1007/BF01308349
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01308349