Laparoscopic common bile duct exploration for bile duct stones: a 6-year experience in a single institution

Abstract

Introduction: Currently, methyl tertiary butyl ether (MTBE) is the only clinically applicable topical agent for gallstone dissolution after having been proven its effectiveness and safety through the worldwide studies. Although generally safe, the widespread use of MTBE is limited by the drawbacks of MTBE, most which is attributed to relatively low boiling point of MTBE and resulting higher evaporation. Method: 2-Methoxy-6-methylpyridine (MMP) is a compound wherein the bulky aliphatic tert-butyl group of MTBE is replaced with an aromatic group, thereby having higher boiling point (156 C). In this study, we were intended to determine the safety and gallstone-dissolving potential of MMP. Results: In the in vitro dissolution test, MMP showed significantly better gallstone-dissolving potential than MTBE, especially at 8 h and 24 h after reaction, respectively (P< 0.05). 24-h incubation with MMP has resulted in 88.2%, 61.5%, and 39.3% dissolubility of cholesterol, mixed, and pigmented gallstones, respectively. The treatment with MTBE did not reduce the viability of human gallbladder epithelial cells nor did increase or decrease the expression of pro-apoptotic marker (Mcl-1) or proliferation marker (PCNA), respectively. In the in vivo dissolution test, MMP exhibited the significantly higher gallstonedissolving potential than MTBE in the both hamster models of cholesterol and pigmented gallstones (P< 0.05). Compared to MTBE. Conclusions: If a clinical trial supports these conclusion, contact litholysis by MMP is expected to be an attractive alternative to laparoscopic cholecystectomy in managing a proportion of patient population with gallstones.