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Analytic Reviews : Nonsurgical Alternatives in the Management of Gallstones

From the Division of Gastroenterology and Nutrition, The George Washington University Medical Center, Washington, DC

Hans Fromm, MD

From the Division of Gastroenterology and Nutrition, The George Washington University Medical Center, Washington, DC

Until recently, the only therapeutic option for patients with symptomatic gallstones was surgery. However, sev eral new and innovative nonsurgical approaches are cur rently available, including oral dissolution therapy with the bile salts, ursodeoxycholic and chenodeoxycholic acids, instillation of liquid solvents such as methyl tert- butyl ether directly into the gallbladder or the common bile duct, and extracorporeal shock-wave lithotripsy. We review the role of each of these methods in the management of patients with gallstones as well as the epidemiology, pathogenesis, natural history, and radi ological characteristics of gallstones, all important con siderations when choosing appropriate treatment for the individual patient.

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