The present status of agents for dissolving gallstones.

Chenodiol therapy appears especially appropriate only for the small group of patients who have floating radiolucent gallstones, are over 60 years of age, and have increased surgical risk factors. Such patients may benefit from a trial of Chenodiol therapy at a dose of 15 mg/kg of body weight and experience both fewer symptoms and reduced need for medically indicated cholecystectomy. Other patients should be evaluated on an individual basis, with consideration given to simple observation for silent gallstones, and to direct intervention if bile duct obstruction occurs. When therapy is chosen, periodic laboratory assessment is indicated and treatment should be continued 3 months beyond apparent dissolution or for 16 months if there is no change in gallstone size. Periodic assessment at annual intervals after dissolution is also indicated because of frequent gallstone recurrence. Where both Chenodiol and UDCA are available, physicians have generally preferred UDCA because of its absence of bile acid diarrhea and liver enzyme changes, even though clinical efficacy is the same.