A 32-year-old woman with symptomatic gallstones wishes to discuss nonsurgical options for her gallstones. Which of the following statement(s) are true?

a.The best commercially available oral dissolution agent, ursodeoxycholic acid, is associated with a complete dissolution rate of less than 50%

Prior to the introduction of laparoscopic cholecystectomy, there was tremendous enthusiasm for a number of nonsurgical techniques for managing gallstones. Dissolution of existing gallstones with pharmacologic agents has been addressed by several national cooperative studies. Ursodeoxycholic acid is the best, safest, and most effective commerically available drug currently available. However, it still has a rate of complete dissolution of only 40%. It is also estimated that only 10% of patients will be suitable candidates for this therapy. Furthermore, gallstone recurrence is a major problem. Actuarial life table analysis indicates that the risk of gallstone recurrence in patients who have undergone dissolution of gallstones with oral bile acid therapy is 50% by five years. The addition of extracorporial shock wave lithotripsy increases the efficiency of gallstone clearance and in selected patients complete fragment clearance can be obtained in over 90% of patients by one year. However, optimal results can be obtained only by setting relatively strict criteria for inclusion. In applying such criteria, less than 20% of patients in the United States would be considered eligible for ESWL. Similar problems with gallstone recurrence have been observed with this technique. Finally, contact dissolution primarily with the ether solvent methyl tert-butyl ether (MTBE) is extremely effective in dissolving cholesterol gallstones. This technique, however, will work only in sto which are composed of cholesterol and the patient must have a demonstrably patent cystic duct before considering this treatment. As with oral dissolution and lithotripsy, gallstone recurrence will remain a problem with this technique.