Medical Dissolution of Gallstones

When Is Cholecystectomy Indicated?
  • Roy M. Preshaw
Chapter
Part of the Topics in Gastroenterology book series (TGEN)

Abstract

Oral agents capable of slow dissolution of cholesterol gallstones are currently prescribed in Western Europe and the United States and will soon be widely available in Canada. The initial enthusiasm for this novel therapy has dimmed slightly following publication of the results of controlled trials, such that at least some authorities have been able to forecast that “cholecystectomy continues to be the treatment of choice for a great majority of patients with cholelithiasis”28; “no more than 10% of gallstone patients can be successfully treated (with dissolution therapy)”47; and “(surgical) treatment, although threatened, is not yet outmoded.”41

Keywords

Medical Dissolution Ursodeoxycholic Acid Gallstone Disease Chenodeoxycholic Acid Cholesterol Gallstone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adler RD, Bennion LJ, Duane WC, et al: Effects of low dose chenodeoxycholic acid feeding on biliary lipid metabolism. Gastroenterology 1975;68:326–334.PubMedGoogle Scholar
  2. 2.
    Albers JJ, Grundy SM, Cleary PA, et al: National Cooperative Gallstone Study. The effect of chenodeoxycholic acid on lipoproteins and apolipoproteins. Gastroenterology 1982;82:638–646.PubMedGoogle Scholar
  3. 3.
    Bachrach WH, Hofmann AF: Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis: A review. Dig Dis Sci 1982;27:737–761, 833–856.PubMedCrossRefGoogle Scholar
  4. 4.
    Bainton D, Davies GT, Evans KT, et al: Gallbladder disease. Prevalence in a South Wales industrial town. N Engl J Med 1976;294:1147–1149.PubMedCrossRefGoogle Scholar
  5. 5.
    Bishop YMM, Mosteller F: Smoothed contingency table analysis, in: Bunker JP, Forrest WP (eds): The National Halothane Study. Bethesda, MD: National Institute of General Medical Sciences, 1969, pp. 238–272.Google Scholar
  6. 6.
    Carroll SE: Indications for cholecystectomy. Can J Surg 1974;17:1–2.PubMedGoogle Scholar
  7. 7.
    Comfort MW, Gray HK, Wilson JM: The silent gallstone: A ten to twenty year follow up study of 112 cases. Ann Surg 1948;128:931–937.CrossRefGoogle Scholar
  8. 8.
    Danziger RG, Hofmann AF, Schoenfield LJ, et al: Dissolution of cholesterol gallstones by chenodesoxycholic acid. N Engl J Med 1972;286:1–8.CrossRefGoogle Scholar
  9. 9.
    Diehl AK, Stern MP, Ostrower VS, et al: Prevalence of clinical gallbladder disease in Mexican-American, Anglo and Black women. South Med J 1980;73:438–443.PubMedCrossRefGoogle Scholar
  10. 10.
    Fedor EJ, Fisher B: The use of radioactive iodine labelled triolein in the evaluation of fat absorption following cholecystectomy. Surg Gynecol Obstet 1960;111:206–210.PubMedGoogle Scholar
  11. 11.
    Galvao H, Menezes ML, Correia JP: The prevalence of gallstones in the Portuguese population: A necropsy study. Ital J Gastroenterol 1981;13:100–104.Google Scholar
  12. 12.
    Glenn F: Biliary tract disease. Surg Gynecol Obstet 1981;153:401–402.PubMedGoogle Scholar
  13. 13.
    Goebell VH, Rudolph HD, Breuer N, et al: The frequency of gallstones in liver cirrhosis. Z Gastroenterol 1981;19:345–355.PubMedGoogle Scholar
  14. 14.
    Gracie WA, Ransohoff DF: The natural history of the silent gallstone: The innocent gallstone is not a myth. N Engl J Med 1982;307:798–800.PubMedCrossRefGoogle Scholar
  15. 15.
    Grundy SM: Mechanism of cholesterol gallstone formation. Semin Liver Dis 1983;3:97–111.PubMedCrossRefGoogle Scholar
  16. 16.
    Hammond EC: Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Public Health 1964;54:11–12.CrossRefGoogle Scholar
  17. 17.
    Karnauchow PN, Mylne GE: Whither cholecystectomy? Can J Surg 1974;17:25–29.PubMedGoogle Scholar
  18. 18.
    Kern F: Epidemiology and natural history of gallstones. Semin Liver Dis 1983;3:87–96.PubMedCrossRefGoogle Scholar
  19. 19.
    LaRusso NF, Hoffman NE, Hofmann AF, et al: Effect of primary bile acid ingestion on bile acid metabolism and biliary lipid secretion in gallstone patients. Gastroenterology 1975;69:1301–1314.PubMedGoogle Scholar
  20. 20.
    Lindstrom CG: Frequency of gallstone disease in a well-defined Swedish population. Scand J Gastroenterol 1977;12:341–346.PubMedCrossRefGoogle Scholar
  21. 21.
    Linos D, O’Fallon WM, Beard CM, et al: Cholecystectomy and carcinoma of the colon. Lancet 1981;2:379–381.PubMedCrossRefGoogle Scholar
  22. 22.
    Lowenfels AB, Domellof L, Lindstrom CG, et al: Cholelithiasis, cholecystectomy and cancer: A case-control study in Sweden. Gastroenterology 1982;83:672–676.PubMedGoogle Scholar
  23. 23.
    Lund J: Surgical indications for cholelithiasis: Prophylactic cholecystectomy elucidated on the basis of long-term follow-up in 526 nonoperated cases. Ann Surg 1960;151:153–162.PubMedCrossRefGoogle Scholar
  24. 24.
    MacLean LD, Goldstein M, MacDonald JE, et al: Results of cholecystectomy in 1000 consecutive patients. Can J Surg 1975;18:459–465.PubMedGoogle Scholar
  25. 25.
    Marks JW, Baum RA, Hanson RF, et al: Additional chenodiol therapy after partial dissolution of gallstones with two years of treatment. Ann Intern Med 1984;100:382–384.PubMedGoogle Scholar
  26. 26.
    Marks JW, Lan SP, Baum RA, et al: Low-dose chenodiol to prevent gallstone recurrence after dissolution therapy. Ann Intern Med 1984;100:376–381.PubMedGoogle Scholar
  27. 27.
    Massarrat VS, Klingemann HG, Kappert J, et al: Incidence of gallstone disease in autopsy material and outpatients from West Germany. Z Gastroenterol 1982,20:341–345.PubMedGoogle Scholar
  28. 28.
    McSherry CK: The National Cooperative Gallstone Study report: A surgeon’s perspective. Ann Intern Med 1981;95:379–380.PubMedGoogle Scholar
  29. 29.
    McSherry CK, Glenn F: The incidence and causes of death following surgery for non-malignant biliary tract disease. Ann Surg 1980;191:271–275.PubMedCrossRefGoogle Scholar
  30. 30.
    Mekhjian HS, Phillips SF, Hofmann AF: Colonic secretion of water and electrolytes induced by bile acids. Perfusion studies in man. J Clin Invest 1971;50:1569–1577.CrossRefGoogle Scholar
  31. 31.
    Mylne GE, Karnauchow PN: Cholecystectomy and related procedures in two community hospitals. Can J Surg 1974;17:20–24.PubMedGoogle Scholar
  32. 32.
    Palmer RH: The gallbladder and bile composition. Am J Dig Dis 1976;21:795–796.PubMedCrossRefGoogle Scholar
  33. 33.
    Plant JCD, Percy I, Bates T, et al: Incidence of gallbladder disease in Canada, England and France. Lancet 1973;2:249–251.PubMedCrossRefGoogle Scholar
  34. 34.
    Price WH: Gall-bladder dyspepsia. Br Med J 1963;2:138–141.PubMedCrossRefGoogle Scholar
  35. 35.
    Ransohoff DF, Grade WA, Wolfenson LB, et al: Prophylactic cholecystectomy or expectant management for silent gallstones: A decision analysis to assess survival. Ann Intern Med 1983;99:199–204.PubMedGoogle Scholar
  36. 36.
    Ryerson E: Aetiology of cholelithiasis with special reference to the age-incidence. Can Med Assoc J 1911;1:832–841.PubMedGoogle Scholar
  37. 37.
    Sampliner RE, Bennett PH, Comess LJ, et al: Gallbladder disease in Pima Indians. Demonstration of high prevalence and early onset by cholecystography. N Engl J Med 1970;283:1358–1364.PubMedCrossRefGoogle Scholar
  38. 38.
    Schoenfield LJ, Lachlin JM: Chenodiol (chenodeoxycholic acid) for dissolution of gallstones: The National Cooperative Gallstone Study. A controlled trial of efficacy and safety. Ann Intern Med 1981;92:257–282.Google Scholar
  39. 39.
    Simmons F, Bouchier IAD: Intraluminal bile salt concentrations and fat digestion after cholecystectomy. S Afr Med J 1972;46:2089–2092.PubMedGoogle Scholar
  40. 40.
    Statistics Canada: Surgical procedures and treatments, 1978. Cat. 82.208. Minister of Supply and Services, Ottawa, Ontario: 1982.Google Scholar
  41. 41.
    Sutherland LR: Medical dissolution of gallstones: An illusion? Can Med Assoc J 1983;129:232.PubMedGoogle Scholar
  42. 42.
    Trotman BW: Pigment gallstone disease. Semin Liver Dis 1983;3:112–119.PubMedCrossRefGoogle Scholar
  43. 43.
    Trotman BW, Soloway RD: Pigment v. cholesterol cholelithiasis: Clinical and epidemiological aspects. Am J Dig Dis 1975;20:735–740.PubMedCrossRefGoogle Scholar
  44. 44.
    Vayda E, Mindell WR, Rutkow IM, et al: A decade of surgery in Canada, England and Wales, and the United States. Arch Surg 1982;117:846–853.PubMedGoogle Scholar
  45. 45.
    Vernick LJ, Kuller LH, Lohsoonthorn P, et al: Relationship between cholecystectomy and ascending colon cancer. Cancer 1980;45:392–395.PubMedCrossRefGoogle Scholar
  46. 46.
    Wenckert A, Robertson B: The natural history of gallstone disease: Eleven-year review of 781 non-operated cases. Gastroenterology 1966;50:376–381.PubMedGoogle Scholar
  47. 47.
    Whiting MJ, Bradley BM, Watts JM, et al: Chemical and physical properties of gallstones in South Australia: Implications for dissolution treatment. Gut 1983;24:11–15.PubMedCrossRefGoogle Scholar
  48. 48.
    Williams CN, Johnston JL: Prevalence of gallstones and risk factors in Caucasian women in a rural Canadian community. Can Med Assoc J 1980;122:664–668.PubMedGoogle Scholar
  49. 49.
    Williams CN, Johnston JL, Weldon KLM: Prevalence of gallstones and gallbladder disease in Canadian MicMac Indian women. Can Med Assoc J 1977;117:758–760.PubMedGoogle Scholar
  50. 50.
    Zak RA, Marks JW, Schoenfield LJ: Current status of chenodeoxycholic acid (chenodiol) therapy of cholesterol gallstones. Semin Liver Dis 1983;3:132–145.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1986

Authors and Affiliations

  • Roy M. Preshaw
    • 1
  1. 1.Department of Surgery and Gastrointestinal Research UnitUniversity of Calgary Medical SchoolCalgaryCanada

Personalised recommendations