Stones in the common bile duct: experience with medical dissolution therapy

Abstract

Summary Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist.

Biliary stenting: Indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline

“…Addition of oral ursodeoxycholic acid to biliary stenting was shown in an RCT to be ineffective for improving stone dissolution [153]. Two uncontrolled studies have suggested that addition of oral ursodeoxycholic acid plus a terpene preparation to biliary stenting might increase the stone dissolution rate [149,154].…”

Toxicological effects ofMentha x piperita(peppermint): a review

“…172 It has been shown that the terpene preparation Rowachol, which contains menthol and menthone, 173 has cholelitholytic activity and its use has been recommended with careful monitoring for potential complications during cholesterol gallstone treatment. 174 A mechanism underlying Rowachol activity may derive from a combination of its cholelitholytic, choleretic and spasmolytic properties which would tend to facilitate the passage of common bile duct gallstones. 174…”

“…174 A mechanism underlying Rowachol activity may derive from a combination of its cholelitholytic, choleretic and spasmolytic properties which would tend to facilitate the passage of common bile duct gallstones. 174…”

Non-Surgical Approaches to Stones in the Biliary Tree

“…All other modalities have failed to produce adequate success. Endoscopic sphincterotomy and ex traction are successful in a high percentage to patients with stones less than 2 cm [65][66][67], Those with previous surgery, bile duct stric tures and duodenal diverticulae may require a combined approach. Percutaneous cannulation and insertion of a wire into the duode num makes it possible to perform endoscopic sphincterotomy in virtually all patients.…”