3 medical options include:
1. Contact dissolution: performed by direct needle puncture of the gallbladder. Methyl tert-butyl ether (MTBE), a potent cholesterol solvent works in 65%, but 70% recur at 4yrs (Dig Dis Sci 1995;40:1775). Passage of the solvent into the duodenum can result in excessive absorption, leading to drowsiness, confusion, and anesthesia.
2. Extracorporeal shock-wave lithotripsy (ESWL): works in 80%, but 70% recur. Only 20% of pt’s qualify as can be used only if <1 radiolucent stone <20mm D with a patent duct, a normal functioning gallbladder, and mild sx’s. Contra if: coagulation and platelet abnormalities, cystic or vascular abnormalities of the liver, acute gallstone-related complications, pregnancy.
3. Oral bile salt therapy: Optimal for small stone size (<1 cm), mild sx’s, normal gallbladder function (normal filling and emptying), buoyant stones on oral cholecystography (suggesting a high cholesterol content) and minimal calcification and low density on CT imaging. Typical use the bile acids, either chenodeoxycholic acid or ursodeoxycholic acid (UDCA). Work by inhibiting biliary secretion of cholesterol, increasing hepatic bile secretion, inhibiting the deposition of cholesterol into stones, and improving gallbladder emptying. All pure cholesterol stones dissolve, however, most gallstones have a mixed composition with calcium salts that limit the efficacy of this form of therapy. If only ideal pt’s are selected dissolution rates may exceed 90%, but <10% of pt’s fall into this category (Medicine 1982;61:86)….thus incomplete dissolution remains a significant problem
On your #3, I have read that getting remaining tiny stones out of the gall bladder via eating fat can be helpful, but it cones with occasional pain.
This (#3) was what my relative did, and it fully resolved, with no more issues.