Pros and cons of the nonsurgical treatments for gallbladder stones.

Dissolution of gallbladder stones is usually possible if the cholesterol content of the stones is high. Oral treatment with chenodiol or ursodiol is least invasive, but also least effective and slow. methyl tert-butyl ether requires delivery by percutaneous transhepatic catheter, but is rapidly effective. Extracorporeal shock wave lithotripsy enhances dissolution by oral bile acids, but is highly effective only for solitary stones less than or equal to 20 mm in diameter. Percutaneous cholecystostomy is most invasive, but effective regardless of stone composition. Stones will probably recur in 50 percent of patients with a patent cystic duct and intact gallbladder.