Dissolution of Gallbladder Stones with Methyl tert -Butyl Ether and Stone Recurrence A European Survey ALFRED HELLSTERN, MD, ULRICH LEUSCHNER, MD, ALA BENJAMINOV, MD, HANNS ACKERMANN, Dr.rer.nat., THOMAS HEINE, Dipl.Inf, DAVIDE FESTI, MD, MONICA ORSINI, MD, ENRICO RODA, MD, TIM C. NORTHFIELD, MD, RIADH JAZRAWI, MD, WINFRIED KURTZ, MD, HANS JOACHIM SCHMECK-LINDENAU, MD, JOCHEN STUMPF, MD, BRITT E. EIDSVOLL, MD, ERLING AADLAND, MD, GERD LUX, MD, ECKHART BOEHNKE, MD, DITMAR WURBS, MD, MYRIAM DELHAYE, MD, MICHEL CREMER, MD, INGOLF SINN, MD, ERICH H È ORING, MD, ULRICH v. GAISBERG, MD, MICHAEL NEUBRAND, MD, TILMANN SAUERBRUCH, MD, VLADIMIR Ï SALAMON, MD, WERNER SWOBODNIK, MD, HASKO v. SANDEN, MD, WOLFGANG SCHMITT, MD, THOMAS K È ASER, MD, HANS SCHOMERUS, MD, JOHANNES GEORG WECHSLER, MD, PAUL JANOWITZ, MD, J È ORN LOHMANN, MD, HEINER PORST, MD, ADOLFO FRANCESCO ATTILI, MD, EBERHARD BARTELS, MD, WOLFGANG ARNOLD, MD, WOLF DIETER STROHM, MD, and FRED PAUL, MD Since there are now several ways to treat symptomatic gallstone disease, one is able to select treatment on the basis of the patient’s comfort, the practicability, effectiveness, and side effects of the technique, and the relative costs. In order to assess the present status of contact dissolution with methyl tert-butyl ether with regard to these aspects, the present enquiry reports the data of 21 European hospitals. Eight hundred three patients were selected for contact litholysis of cholesterol gallbladde r stones using methyl tert -butyl ether. Percutane ous transhepatic puncture of the gallbladde r was performed under x-ray or ultrasound guidance. Dissolution rate, side effects, and treatment times of 268 patients from one single center were compared to those of 535 patients from the other 20 centers. Two hundre d sixty-four patients were followed for ®ve years to assess stone recurrence. Physicians were asked how they assessed the expenditure of the method, the discomfort to the patients, and the staf®ng situation. Patients were asked to indicate their acceptance on an analog scale. Puncture was successful in 761 (94.8% ) patients. Prophylactic administration of antibiotics was not neces- sary. Stones were dissolve d in 724 (95.1% ) patients. In 315 (43.5% ) sludge remained in the gallbladde r. The most severe complication was bile leakage, which led 12 (1.6% ) patients to have elective cholecystectomy. Toxic injurie s due to the ether were not reported. Method- related lethality amounted to 0% , 30-day-le thality to 0.4% . Stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over ®ve years. Patients with multiple stones developed recurrent stones almost twice as often as those with solitary stones. The probability of stone recurrence in patients with sludge in the gallbladde r after catheter removal was not statistically signi®cantly different from those without sludge. Seventy to 90% of the centers found the puncture to be simple and not distressing for patients and the relation between expenditure and therapeutic success to be acceptable. The acceptance of contact litholysis by the patients was excellent. Contact litholysis when applied by an Digestive Diseases and Sciences, Vol. 43, No. 5 (May 1998), pp. 911±920 911 Digestive Diseases and Sciences, Vol. 43, No. 5 (May 1998) 0163-2116/98/0500-0911$15.00/0 Ñ 1998 Plenum Publishing Corporation