A Study of Ursodeoxycholic Acid for Dissolution of Gallstones

Background: Gallstone disease one of the major health problems and causes of morbidity in Bangladesh as well as worldwide. Ursodeoxycholic acid is a bile acid which is used for dissolving gallstones.Objectives: To observe dissolution of gallstones among the patients of gallstone disease by use of ursodeoxycholic acid. Methods: It was a cross-sectional observational study carried out in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi from July, 2014 to June, 2016. According to inclusion and exclusion criteria 12 people having gallstone disease were selected whose stone size were <10mm and were treated withUrsodeoxycholic acid (Dosage of 8-12mg/kg/day). Thorough history, physical examination along with Ultrasonographical assessment were done for this study.Results: Complete gallstonedissolution with Ursodeoxycholic acid occurred in 08(66.67%) cases whereas dissolution did not occur in 04(33.33%) cases among the patients of gallstone diseases.Conclusion: In this study, complete dissolution of Gallstones (<10mm) occurred in 66.67% patients.TAJ 2014; 27(2): 27-29

CHOLELITHIASIS IN INFANTS – CONSERVATIVE OR SURGICAL TREATMENT?

The aim of the research: to optimize the treatment strategy of cholelithiasis in infants by studying the conservative therapy and surgical treatment effectiveness.Children with cholelithiasis were divided into three groups: 60 children received conservative treatment; 14 children were not treated; 22 children underwent cholecystectomy. Conservative treatment was carried out by administration of Ursofalk suspension (Dr. Falk Farma, Germany) on the daily dose basis – 20 mg/kg of body weight per day once a day – at bedtime. Duration of litholysis ranged from 6 to 24 months. The therapeutic effect was controlled every 3 months by ultrasound examination of the bile ducts and biochemical analysis of blood serum.Results. Contractile function of the gallbladder normalized after 6 months, biochemical markers of cholestasis after 3 weeks, lipidogram by the end of the second year of conservative treatment. All children tolerated therapy well. No side effects were found. No spontaneous dissolution of gallstones was observed in 14 children who did not receive litholytic therapy. In 22 children, who underwent surgery, morphological changes in the gallbladder wall were reversible, but most of them formed post-cholecystectomy syndrome. In view of the aforesaid, conservative therapy should be considered the priority method of cholelithiasis treatment in children under 3 years of age. Surgical treatment should be performed only according to vital indications.

Chemical-Contact Dissolution of Gallstones in a Critically Ill Patient - A Case Report

Einleitung: Vor der Ära der laparoskopischen Cholezystektomie und der endoskopischen Steinextraktion waren die nichtchirurgischen Therapien bei der Behandlung von symptomatischen Gallensteinen, wie die Kontaktlitholyse mit Äther, eine valable Alternative. Bei inoperablen Patienten mit akuter Cholezystolithiasis und endoskopisch nicht zugänglichen Gallensteinen kann auch heute noch erfolgreich darauf zurückgegriffen werden. Fallbeispiel: Bei einem 85-jährigen Patienten in schlechtem Allgemeinzustand und einer Cholangiosepsis nach endoskopischer Papillotomie und partieller Steinextraktion wurde bei drohender Gallenblasenperforation infolge progredientem Hydrops ultraschallkontrolliert ein perkutaner pigtail Katheter eingelegt. Nach mehrmaliger Instillation von Methyltertbutyläther (MTBE) über den liegenden Drain in Gallenblase und Gallenwege gelang es, die Restkonkremente aufzulösen. Der Patient ist drei Monate nach Eingriff beschwerdefrei. Diskussion: Symptomatische Gallensteine, bei denen endoskopische Verfahren nicht zum Erfolg führen, sind selten. Kommt ein drohender Gallenblasenhydrops hinzu, ist die perkutane Drainage der Gallenblase und anschliessende Kontaktlitholyse mit MTBE eine patientenschonende, effektive Therapieform. Die Erfolgsrate liegt bei nicht verkalkten Gallensteinen bei 70 bis 95%, je nach Grösse und Anzahl der Konkremente. Die Methode zeichnet sich zudem durch eine geringe Morbidität aus. Schlussfolgerungen: Bei inoperablen Patienten mit schwerer Cholezystitis und Gallenblasenhydrops ist die perkutane Drainage der Gallenblase und eine Kontaktlithothripsie durch MTBE eine patientenschonende, sichere und kostengünstige Therapie.

Dissolution of gallstones in vitro

With the help of ultrasound and NMR tomography, the diagnosis of stones in the biliary tract has improved significantly. In this regard, the number of patients who want to get rid of stones, the existence of which they did not even suspect before the examination, is growing significantly. The low trauma of laparoscopic cholecystectomy (LCE) is captivating, and there is a danger of expanding the indications for this, already quite common operation. But the removal of the organ necessary for digestion excludes the possibility of new painful disorders.