Monooctanoin, a dissolution agent for retained cholesterol bile duct stones: physical properties and clinical application.

A commercial emulsifying agent consisting largely of glyceryl-l-monooctanoate (monooctanoin) was found to be an excellent cholesterol solvent. In vitro, the agent dissolved mixed cholesterol gallstones more than twice as fast as sodium cholate solutions, which have been previously used for dissolution of retained cholesterol bile duct stones by T-tube infusion. To test clinical efficacy, the solvent was infused, via T-tube, into 12 patients with retained bile duct stones. Some or all of the stones disappeared in 10 patients during biliary tract infusion of monooctanoin for 4--21 days. Stones from the 2 patients whose stones did not disappear were removed surgically and in vitro were found to be insoluble in monooctanoin. Monooctanoin infusions were well tolerated. This digestible solvent appears to be a useful substance for direct physical dissolution of retained bile duct stones by T-tube infusion.