Journal of Gastroenterology

, Volume 29, Issue 4, pp 486–494 | Cite as

Direct dissolution of gallstones with methyl tert-butyl ether (MTBE) via endoscopic transpapillary catheterization in the gallbladder (ETCG)

  • Naohito Uchida
  • Toshiaki Nakatsu
  • Shuko Hirabayashi
  • Atsushi Minami
  • Hiroki Fukuma
  • Toru Ezaki
  • Syed Ahmed Morshed
  • Chiaki Fuke
  • Kiyoshi Ameno
  • Iwao Ijiri
  • Mikio Nishioka


In a pilot study of direct dissolution therapy of gallstones with methyl tert-butyl ether (MTBE), endoscopic transpapillary catheterization in the gallbladder (ETCG) was performed. Complete dissolution was seen in 8 out of 12 (66%) patients and partial dissolution was seen in 2 (16%) patients. In one of the 8 complete dissolution patients, combined extracorporeal shock wave lithotripsy (ESWL) and dissolution therapy was carried out successfully. These 8 patients were followed up for 12–20 months with regular ultrasonography. During this period, 1 patient underwent laparoscopic cholecystectomy due to stone recurrence. Thickening of the gallbladder wall was seen in 2 patients, but there were no other complications. Using Tsuchiya's classification based on ultrasound, complete dissolution was seen in type Ia stones. This pilot study suggests that the direct dissolution of gallstones with MTBE via ETCG might be a useful and safe non-invasive treatment in patients with cholesterol stones in preserved gallbladders.

Key words

ETCG gallstone dissolution therapy MTBE ESWL 


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  1. 1.
    McSherry CK, Glen F. The incidence and causes of death following surgery for non-malignant biliary tract disease. Ann Surg 1980;191:271–279.PubMedGoogle Scholar
  2. 2.
    Tschmelitsch J, Glaser K, Klingler A, et al. Late complication caused by stone spillage during laparoscopic cholecystectomy (letter). Lancet 1993;342:369.CrossRefPubMedGoogle Scholar
  3. 3.
    Allen MJ, Borody TJ, Bugliosi TF, et al. Rapid dissolution of gallstones by methyl tert-butyl ether. Preliminary observations. N Engl J Med 1985;312:217–220.PubMedGoogle Scholar
  4. 4.
    Zakko SF, Hofmann AF. Gallstone dissolution with methyl tert-butyl ether (MTBE). In vitro comparison of a microprocessor-assisted solvent transfer (MAST) system with a syringe pump method (abstract). Hepatology 1988;8:1254.Google Scholar
  5. 5.
    Sauerbruch T, Delius M, Paumgartner G, et al. Fragmentation of gallstones by extracorporeal shock waves. N Engl J Med 1986;314:818–822.PubMedGoogle Scholar
  6. 6.
    Sackmann M, Delius M, Sauerbruch T, et al. Shock wave lithotripsy of gallbladder stones: The first 175 patients. N Engl J Med 1988;318:393–397.PubMedGoogle Scholar
  7. 7.
    Allen MJ, Borody TJ, Thistle JL. In vitro dissolution of cholesterol gallstones: A study of factors in fluencing rate and a comparison of solvents. Gastroenterology 1985;89:1097–1103.PubMedGoogle Scholar
  8. 8.
    Allen MJ, Borody TJ, Bugliosi TF, et al. Cholelitholysis using methyl tertiary butyl ether. Gastroenterology 1985;88:122–125.PubMedGoogle Scholar
  9. 9.
    Little CJ, Dale AD, Whatley JA, Wickings JA. Methyl tertiary-butyl ether: A new chromatographic cluent. J Chromatogr 1979;169:381–385.Google Scholar
  10. 10.
    McGahan JP, Tesluk H, Brock JM, et al. Dissolution of gallstones in animal model using methyl-tertiary butyl ether. Invest Radiol 1988;23:599–603.PubMedGoogle Scholar
  11. 11.
    van Sonnenberg E, Zakko S, Hofmann AF, et al. Human gallbladder morphology after gallstone dissolution with methyl tert-butyl ether. Gastroenterology 1991;100:1718–1723.Google Scholar
  12. 12.
    Thistle JL, May GR, Bender CE, et al. Dissolution of cholesterol gallbladder stones by methyl-tert-butyl ether administered by percutaneous transhepatic catheter. N Engl J Med 1989;320:633–639.PubMedGoogle Scholar
  13. 13.
    van Sonnenberg E, Casola G, Zakko SN, et al. Gallbladder and bile duct stones: Percutaneous therapy with primary MTBE dissolution and mechanical methods. Radiology 1988;169:505–509.Google Scholar
  14. 14.
    Igimi H, Hisatsugu T. Studies on the direct solubilizer of terpene preparation for cholesterol retained gallstones (in Japanese). Jpn J Gastroenterolog Surg 1974;7(6):586–603.Google Scholar
  15. 15.
    Yamashita N. Experimental studies on dissolution of cholesterol gallstones using MTBE (in Japanese). Jpn J Gastroenterol 1990;87:1191–1202.Google Scholar
  16. 16.
    Leushner U, Hellstern A, Schmidt K, et al. Gallstone dissolution with methyl tert-butyl ether in 120 patients—efficacy and safety. Dig Dis Sci 1991;36:193–199.Google Scholar
  17. 17.
    Ponchon T, Baroud J, Pugol B, et al. Renal failure during dissolution of gallstone by methyl tert-butyl ether (letter). Lancet 1988;II:176–177.Google Scholar
  18. 18.
    Foerster EC, Matek W, Domschke W. Endoscopic retrograde canulation of the gallbladder: Direct dissolution of gallstones. Gastrointest Endosc 1990;36:444–450.PubMedGoogle Scholar
  19. 19.
    Williams HJ Jr, Bender CE, LeRoy AJ. Dissolution of cholesterol gallstones using methyl tert-butyl ether. Cardiovasc Intervent Radiol 1990;13:272–277.PubMedGoogle Scholar
  20. 20.
    Soehendra N, Schulz H, Nam VC, et al. ESWL and gallstone dissolution with MTBE via a naso-vesicular catheter. Endoscopy 1990;22:176–179.PubMedGoogle Scholar
  21. 21.
    Hirabayashi S, Nakatsu T, Nishioka M. The double contrast method by endoscopic transpapillary catheterization in the gallbladder. Dig Endosc 1990;2:40–46.Google Scholar
  22. 22.
    Nakatsu T, Hirabayashi S, Nishioka M. Evaluation of endoscopic naso-biliary drainage established without endoscopic sphincterotomy for malignant obstructive jaundice. Dig Endosc 1990;2:207–213.Google Scholar
  23. 23.
    Hellstern A, Leuschner M, Frenk H, Dillinger HW, Caspary W, Leuschner U. Gallstone dissolution with methyl tert-butyl ether: How to avoid complications. Gut 1990;31:922–925.PubMedGoogle Scholar
  24. 24.
    Caroli A, Favero GD, Mario FD, et al. Comuted tomography in predicting gallstone solubility: A prospective trial. Gut 1992;33:698–700.PubMedGoogle Scholar
  25. 25.
    Baron RL, Kuyper SJ, Lee SP, et al. In vitro dissolution of gallstones with MTBE: Correlation with characteristics at CT and MR imaging. Radiology 1989;173:117–121.PubMedGoogle Scholar
  26. 26.
    Nelson JA, Kuyler SJ, Lee SP, Rohrmann CA, Shuman WP, Nelson JA. In vitro dissolution of gallstones with MTBE: Correlation with characteristics at CT and MR imaging. Radiology 1989;173:117–121.PubMedGoogle Scholar
  27. 27.
    Tsuchiya Y, Ohuji M, Yazawa T, Nakamura H. Ultrasonic properties of gallstones—differentiation between cholesterol stones and pigment stones (in Japanese). Gallbladder and Pancreas 1986;7:1483–1491.Google Scholar
  28. 28.
    Hickman MS, Schwesinger WH, Bova JD, Kurtin WE. Computed tomographic analysis of gallstones. Arch Surg 1986;121:289–291.PubMedGoogle Scholar
  29. 29.
    Lu DSK, Ho CS, Allen LC. Gallstone dissolution in methyl tert-butyl ether after mechanical fragmentation: In vitro study. AJR 1990;155:67–72.PubMedGoogle Scholar
  30. 30.
    Faulkner DJ, Kozarek RA. Gallstones: Fragmentation with a tunable dye laser and dissolution with methyl tert-butyl ether in vitro. Radiology 1989;170:185–189.PubMedGoogle Scholar
  31. 31.
    Smith BF. Effect of laser fragmentation of cholesterol and mixed gallstones on in vitro dissolution in methyl tert-butyl ether. Dig Dis Sci 1990;35:236–241.PubMedGoogle Scholar
  32. 32.
    Holl J, Sauerbruch T, Sackmann M, et al. Combined treatment of symptomatic gallbladder stones by extracorporeal shock wave lithotripsy (ESWL) and instillation of methyl tert-butyl ether (MTBE). Dig Dis Sci 1991;36:1097–1101.CrossRefPubMedGoogle Scholar
  33. 33.
    Adam G, Knuechel R, Vorwerk P, et al. Tissue response of the biliary and digestive system of rabbits after MTBE infusion into the gallbladder. Invest Radiol 1990;25:58–61.PubMedGoogle Scholar
  34. 34.
    Esch O, Spinosa JC, Hamilton RL, et al. Acute effects on gallbladder histology of topical methyl tert-butyl ether or ethyl propionate in animals. Hepatology 1992;16:984–991.PubMedGoogle Scholar
  35. 35.
    Esch O, Schteingant CD, Pappert D, et al. Increased blood levels of methyl tert-butyl ether but not of ethyl propionate during instillation of contact gallstone dissolution agents in the pig. Hepatology 1993;18:373–379.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Naohito Uchida
    • 1
  • Toshiaki Nakatsu
    • 1
  • Shuko Hirabayashi
    • 1
  • Atsushi Minami
    • 1
  • Hiroki Fukuma
    • 1
  • Toru Ezaki
    • 1
  • Syed Ahmed Morshed
    • 1
  • Chiaki Fuke
    • 2
  • Kiyoshi Ameno
    • 2
  • Iwao Ijiri
    • 2
  • Mikio Nishioka
    • 1
  1. 1.Third Department of Internal MedicineKagawa Medical SchoolKagawaJapan
  2. 2.Forensic MedicineKagawa Medical SchoolKagawaJapan

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