Gallstones composed of a mixture of cholesterol, calcium bilirubinate, proteins, and mucin, can range from the size of a salt grain to as large as a golf ball and can cause severe inflammation. Cholecystectomy or gallbladder removal surgery is most commonly advised to avoid these conditions and also to alleviate pain caused by gallstones. However, since the surgical removal of gallstones involves the removal of an entire organ, there is growing interest in exploring some non-surgical treatment alternatives.
1. Oral Pills
Long-term administration of bile acid pills containing certain chemicals like ursodiol or chenodiol is helpful in dissolving gallstones. Ursodiol, i.e., ursodeoxycholic acid reduces cholesterol saturation of bile both by reducing liver cholesterol secretion as well as by lowering the detergent effect of bile salts in the gallbladder. Thinning of bile, hence, allows gallstones to dissolve. While these pills can be effective and usually tolerated well by patients, the treatment is limited to get rid of only small stones made of cholesterol.
2. Extracorporeal Shock Wave Lithotripsy (ESWL)
The treatment involves fragmenting gallstones by sending shock waves through the soft tissue of the body. Being most effective on small, solitary gallstones, ESWL is limited to less than 15% of patients. A fluoroscopic x-ray imaging system or an ultrasound imaging system is used to locate the stone and aim the treatment. The length of gap between the acoustic pulses is controlled to allow cavitation bubbles to disperse minimizing tissue damage.
3. Endoscopic Sphincterotomy
Endoscopic retrograde sphincterotomy can be used to cannulate the intraduodenal portion of bile duct through the sphincter of Oddi, creating an opening through which stones can be extracted.
The location of the sphincterotomy should be between the 11 and 1 o’clock position. Deep cannulation is then facilitated. Once deep cannulation is achieved, the endoscopist can withdraw the sphincterotome tailored to the desired incision length. The incision should be directed along the longitudinal axis of the intramural segment of the common bile duct and should never be continued beyond the junction of the intramural segment and the duodenal wall.
Since during the initial portion of the sphincterotomy, the pancreatic orifice is at a proximity, the risk of causing pancreatitis may be highest. Towards the end, the blood vessels are near, hence, there is a risk of causing bleeding.
4. Contact Dissolution Therapy
Under this, a solvent known as methyl tertiary-butyl ether (MTBE) is injected into the gallbladder to dissolve the gallstones. Studies have indicated that the ether remains liquid at body temperature and dissolves gallstones within 5 - 12 hours. However, there are serious side effects of the procedure including severe burning pain. Since this is a technically difficult and hazardous procedure, it requires a careful approach.
5. Percutaneous Cholecystostomy
This non-surgical treatment option is effective when followed by a surgical gallbladder removal. Percutaneous cholecystostomy is typically for those patients who are incapable of tolerating surgery directly.
The gallbladder can be punctured with a trocar needle-catheter or by using a Seldinger technique. Bile samples are collected for Gram staining and cultures. A small amount of contrast agent is injected to confirm the position of the catheter, and the catheter is secured to skin by using suture material. It is left to drain by gravity. The catheter is left in place for weeks, followed by a gallbladder removal surgery to prevent recurrence. Most clinicians prefer a transhepatic approach because a transperitoneal approach poses a risk of bile peritonitis. However, a transperitoneal approach can be used if the gallbladder is greatly distended.
Treatment of Kidney Stones
Kidney Stones (Scientific Name: Renal Calculus) results from an amassing of dissolved minerals that accumulate on the inner surface of kidneys. Depending on the amount of deposit, these stones can grow as big as a golf ball. They have a sharp and crystalline structure, and generally comprise of the compound calcium oxalate. Read More...
