We report a series of 10 elderly patients with large bile duct
calculi refractory to standard endoscopic extraction techniques who were treated by
gall stone dissolution using methyl tertiary butyl
ether (
MTBE) instilled through a nasobiliary
catheter. In eight patients complete bile duct clearance was achieved after an average of eight hours
MTBE instillation. In two patients
gall stone size did not change. Both underwent operative
gall stone removal and subsequent stone analysis showed low
cholesterol content, which is unlikely to respond to
MTBE. Apart from occasional transient
nausea and drowsiness, no adverse reactions were noted. Methyl tertiary butyl
ether appears to be a powerful in vivo
gall stone dissolution agent which, from preliminary studies, is not associated with serious toxicity.