American Journal of Roentgenology, Vol 155, 67-72, Copyright © 1990 by American Roentgen Ray Society
Gallstone dissolution in methyl tert-butyl ether after mechanical fragmentation: in vitro study
DS Lu, CS Ho and LC Allen
Department of Radiology, Toronto Hospital, Ontario, Canada.
Twenty sets of three gallstones matched for weight and appearance were
selected from 20 surgically resected human gallbladders to test the effect
of intracorporeal mechanical fragmentation on gallstone dissolution with
methyl tert-butyl ether in vitro. One stone from each set was fragmented by
a mechanical lithotriptor and then treated with methyl tert-butyl ether,
and one was used as control and was treated intact. The third stone was
analyzed for its density pattern on CT and biochemically for its
cholesterol and calcium content. On the basis of CT appearance, the stones
were classified as noncalcified, partially calcified, or heavily calcified.
Mechanical fragmentation reduced dissolution time by 25-69% (mean +/- SD,
44 +/- 16%) for the noncalcified stones and by 20-42% (mean +/- SD, 30 +/-
8%) for the partially calcified stones. No significant reduction was
observed for the heavily calcified stones. The degree of reduction was
inversely related to maximal stone density (r = -.72) and was independent
of its pattern of calcification. This study shows that mechanical
fragmentation is effective in accelerating gallstone chemolysis by methyl
tert-butyl ether for noncalcified and partially calcified but not for
heavily calcified stones.
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