Oral Dissolution Therapy
Oral dissolution therapy uses bile acids in pill form to dissolve The technique is generally safe but only moderately effective, since gallstones recur in the majority of patients. In addition, this therapy works only on cholesterol-based stones that are less than 1.5 cm in diameter and is less effective in obese patients.
Ursodiol or ursodeoxycholic acid (Actigall) is the oral bile acid drug which is approved for dissolution. Patients with small stones of high cholesterol content are most likely to benefit from this treatment, although a recurrence rate of 10% per year for the first five years has been reported in patients on this therapy. The drug is considered to be one of the safest common drugs and does not seem to have significant side effects. Gallstones that are calcified or composed of bile pigments are not amenable to oral dissolution therapy. Only a small percentage of patients are candidates for oral dissolution therapy. Ursodiol is very expensive; the treatment can take up to two years can cost thousands of dollars per year, and may ultimately be unsuccessful. For these reasons, this option is rarely considered to be appropriate for symptomatic gallstones.