A physician at the Health Center has developed a new treatment for gallstone disease that works in a day; avoids surgery; and often includes ice cream as part of the treatment.

Instead of surgically removing the gallbladder with its gallstones, Dr. Salam Zakko, professor of medicine, treats the gallstones with a solvent that breaks them up so they can be removed.

Image: Salam Zakko
Dr. Salam Zakko has developed a new, non-surgical procedure to remove gallstones that may soon become the standard treatment.Photo by Peter Morenus

It’s done using a catheter inserted into the gallbladder to inject the solvent, ethyl propionate, a naturally occurring compound found in grapes and wines. The substance is approved by the Food and Drug Administration as a food additive.

The procedure takes a couple of hours and requires only local anesthesia. It eliminates the need for a hospital stay and the long recuperation associated with surgery to remove the gallbladder, which is the typical treatment for gallstone disease.

And the ice cream? “There is a possible side effect of leakage of bile through the hole created in the gallbladder by the catheter,” says Zakko, “but we’ve found that if we give our patients some fatty foods such as ice cream, the gallbladder contracts, sealing the hole.

The gallbladder’s main function is to concentrate and store bile and then eject bile into the intestine when needed to aid in the digestion and absorption of fats, among other things, explains Zakko. Ice cream is high in fat, and that makes the gallbladder contract to put the bile into the intestine. In the process, it helps close the hole created by the catheter.

“There are a lot of happy people around the state and the country because of this treatment,” he adds.

Gallstone disease is a very common disorder, with about 1.2 million new cases diagnosed each year in this country alone. The gallstones are usually made of cholesterol and can grow up to an inch across. Most gallstones take years to form and in many people they provoke no symptoms at all. In others, they cause severe abdominal pain, inflammation, and intolerance to fatty foods. They can also cause jaundice and pancreatitis when they obstruct the bile or pancreatic ducts.

The standard treatment has long been surgical removal of the gallbladder – cholecystectomy – and more than 750,000 are performed nationwide every year.

Zakko says surgery to remove the gallbladder is generally successful and relatively benign; but it requires a hospital stay and involves a fairly long recuperation. Some people also experience long-term side effects, including diarrhea.

“There are many people, especially older patients, who may not be good candidates for the surgery because of other medical problems, like heart disease,” he adds. “For these people, the non-surgical procedure is their only treatment option.”

There is also growing evidence that removal of the gallbladder doubles the risk of colon cancer, notes Zakko, perhaps because of the related increase of bile in the colon.

The non-surgical procedure, which is available only at the UConn Health Center, is still considered investigational.

Approval by the Food and Drug Administration requires establishment of a commercial entity to make the instruments and supplies necessary to carry out the procedure, the completion of clinical trials and review of the data, a process that could take several years.

“I believe we have enough data, so I am no longer actively looking for patients for the clinical trial,” says Zakko. “The trial is, however, still active and available for those high-risk patients who cannot have surgery. I believe this procedure for dissolving gallstones without invasive surgery may be the new standard for treatment of symptomatic gallbladder stones within just a few years.”


Author: Kristina Goodnough

Source:http://advance.uconn.edu/2002/021112/02111208.htm

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