Chemical contact dissolution of cholesterol gallbladder stones. One hundred years later.

The demonstration that methyl tert-butyl ether is a safe and effective gallstone solvent and the development of the microprocessor-assisted solvent transfer system have revived the procedure of chemical contact dissolution of gallbladder stones, which was first described 100 years ago. This procedure of automatic computerized solvent litholysis is further enhanced by the development of a CT-index for the selection of patients with amenable stones and percutaneous gallbladder endoscopy for evaluation after dissolution. Preliminary studies have shown that ACSL with MTBE is safe and highly effective for gallbladder stone dissolution, making this technique a viable non-surgical alternative for the treatment of gallbladder stones. The emergence of new safer and more effective solvent such as ethyl propionate along with the procedure of percutaneous gallbladder ablation for the definitive prevention of gallstone recurrence promise to render ACSL highly competitive even with laparoscopic cholecystectomy.