[Therapy of cholelithiasis. Advances and disappointments in the last 50 years]

Abstract

For many decades cholecystectomy has been the standard treatment for symptomatic cholecystolithiasis. In asymptomatic patients a waiting attitude can be taken. In recent years, non-surgical therapies have been developed for selected patients. Thus, in patients with mild or no symptoms medical dissolution of gallstones with ursodeoxycholic acid, chenodeoxycholic acid or a combination of these two bile acids can be tried if radiolucent stones with diameters below 15 mm are present in a functioning gallbladder (not more than half full of stones). Besides this therapy, cholelithotripsy with extracorporeal shock waves represents a new procedure, which, together with percutaneous or retrograde instillation of methyl tert-butyl ether, needs further evaluation. For elimination of stones from the common bile duct, endoscopic sphincterotomy and stone extraction have proved valuable non-surgical procedures. For choledochal stones not amenable to endoscopic extraction or dissolution by instillation of solvents, treatment by extracorporeal shock waves represents a valuable alternative to surgery. Thus, the past decades have not only brought progress in knowledge of gallstone disease but have also broadened the therapeutic armoury. Therefore, it is essential to select the most appropriate method for each situation.