Expectant management is indicated for most patients with silent gallstones.
These agents expand the bile acid pool and also lower biliary secretion of cholesterol by inhibiting hepatic cholesterol synthesis. Complete gallstone dissolution takes months to years. When small amounts of the solvent methyl tert-butyl ether are pumped into the gallbladder, stones are readily dissolved and can be removed. Side effects include pain from catheterization and occasionally anesthetization from the ether. Extracorporeal shock-wave lithotripsy, the treatment of choice for kidney stones, has also proved to be effective for noncalcified gallstones.