What are alternatives to Cholecystectomy?

There are alternatives to surgery for both stones in the gallbladder and stones in the bile duct. ERCP can be used to find stones in the bile duct, as described above. When duct stones are seen, the doctor can widen the bile duct opening and pull the stones into the intestine. This is commonly done when the gallbladder is being removed laparo–scopically or when a stone is found in the duct long after gallbladder surgery. It may also be done to relieve symptoms from a bile duct stone, even when other stones are present in the gallbladder, if a patient is too frail to undergo gallbladder surgery.

Gallbladder stones can be dissolved by a chemical (ursodiol or chenodiol), which is available in pill form. This medicine thins the bile and allows stones to dissolve. Unfortunately, only small stones composed of cholesterol dissolve rapidly and completely, and its use is therefore limited to patients with the right size and type of stones.

Two experimental approaches to gallbladder stones have been studied, but the results have thus far been disappointing. Patients with one or two larger cholesterol stones have been successfully treated with lithotripsy, a technique in which sound waves are focused onto stones which causes them to disintegrate. However, the fragments remain in the gallbladder unless ursodiol or chenodiol is taken to dissolve them. Patients with cholesterol stones have also been treated with methyl tertbutyl ether, a chemical which can be injected into the gallbladder until the stones dissolve. This chemical is harsh and some complications have been reported.

A problem with all non–surgical approaches is that gallstones return several years later in about half the patients successfully treated.

What is the liver?

The liver weighs about three pounds and is the largest organ in the body. It is located in the upper right side of the abdomen, below the ribs. When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis.

The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.

What is the impact of Cirrhosis?

Cirrhosis is the eleventh leading cause of death by disease in the United States. Almost one–half of these are alcohol related. About 25,000 people die from cirrhosis each year. There also is a great toll in terms of human suffering, hospital costs, and the loss of work by people with cirrhosis.

What are the major causes of Cirrhosis?

Cirrhosis has many causes. It can result from direct injury to the liver cells (i.e., hepatitis) or from indirect injury via inflammation or obstruction to bile ducts which drain the liver cells of bile. Common causes of direct liver injury include chronic alcoholism (most common cause in the United States), chronic viral hepatitis (types B, C, and D) and auto immune hepatitis. Common causes of indirect injury by way of bile duct damage include primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia (common cause of cirrhosis in infants).

Less common causes of cirrhosis include direct liver injury from inherited disease such as cystic fibrosis, alpha–1–antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage disease.

Two inherited disorders result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis. People with Wilson’s disease store too much copper in their liver, brain, kidneys, and in the corneas of their eyes.

In another disorder, known as hemochromatosis, too much iron is absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart and endocrine glands.

If a person’s bile duct becomes blocked, this also may cause cirrhosis. The bile ducts carry bile formed in the liver to the intestines, where the bile helps in the digestion of fat.

In babies, the most common cause of cirrhosis due to blocked bile ducts is a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver. These babies are jaundiced (their skin is yellowed) after their first month of life. Sometimes they can be helped by surgery in which a new duct is formed to allow bile to drain again from the liver.
In adults, the bile ducts may become inflamed, blocked, and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.

Very rare causes of cirrhosis include: reactions to drugs (e.g., vitamin A, methotrexate, amiodarone) exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.