Of 125 patients with radiolucent
gallstones in functioning gallbladders treated with
chenodeoxycholic acid (CDCA) between 1971 and 1977, 47 showed complete
gallstone dissolution--an overall efficacy of 38%. However, a retrospective analysis of factors governing efficacy carried out in 1976 showed that in patients with stones less than 15 mm in diameter, treated with greater than 13 mg CDCA kg-1 day-1 for not less than one year who developed unsaturated bile (n = 27), efficacy rose to 78% complete and 93% partial plus complete
gallstone dissolution. The usefulness of this selection/management approach was then confirmed prospectively in 42 comparable patients selected for treatment since 1977, efficacy (complete
gallstone dissolution) reached 76%. The median
duration of treatment for complete
gallstone dissolution was 7.5 months for stones less than 5 mm in diameter, 12.0 for 5-10 mm stones; 22.0 for 10-15 mm stones and 28.5 for the only two patients (of 26) with large (greater than 15 mm) stones who ultimately showed complete
gallstone dissolution. Seventy-eight patients withdrew from
therapy, 21 within 6 months of starting CDCA (before their first follow-up cholecystogram): the remaining 57 withdrew because of: complications of
gallstones (11 patients), inadequate treatment (dose and/or duration, 20 patients), inappropriate selection or unsuitable stones (19 patients) and resistance to CDCA (7 patients).
Diarrhea, although common, was usually mild or transient. Biliary
colic and non-specific
dyspepsia tended to improve during
therapy. To date,
gallstone recurrence has been detected in 14 patients (30%), 3 months to 5 years after discontinuing treatment with CDCA.