The nonsurgical management of gallstone disease has drawn widespread clinical interest during the last decade as ultrasound surveys have indicated that cholelithiasis is predom inantly an asymptomatic condition and much more prevalent than previously thought. This book presents an overview of the pathophysiologic and pathobiochemical principles of gallstone formation and the consequences for clinical therapeutic regimens. New information concerning the balance between vesicular and micellar transport of choles terol, early cholesterol nucleation, and the influence of inhibiting and promoting com pounds for cholesterol nucleation as well as information concerning the effects of changes in gallbladder motility and gallbladder mucosal function is reviewed. In order to make further progress in developing treatments which facilitate gallstone dissolution and in preventing disease, it is necessary to integrate this new data into our thinking. Methods of treatment such as systemic litholysis of cholesterol gallbladder stones with bile acid preparations and mechanical fragmentation of stones either by extracorpo ral shock waves or intracorporal laser systems are carefully described and separate discussions of direct contact litholysis of cholesterol stones with ether preparations and the local litholytic treatment of calcified pigment stones are included. New therapeutic applications of HMG-CoA-reductase inhibitors and nonsteroidal anti-inflammatory drugs are also critically reviewed. Finally, for the interested reader an evaluation of prophylactic treatment against stone recurrence after successful conservative treatment and an appraisal of alternative management strategies supplement the information on the conservative treatment of gallstones.

Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processses

Increased Biliary Lithogenicity Through Cholesterol Supersaturation
Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis
Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems
Pigment Gallstones and Secondary Calcification of Gallstones
The Influence of the Gallbladder Epithelium on Gallstone Formation
Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors
Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin
Environmental Factors and Gallstones
Different Therapeutic Approaches to Gallstone Disease
Is Therapeutic Intervention Necessary in Gallstone Disease? The Surgeon's Point of View
Surgical Therapy for Acute Gallstone Complications
Therapeutic Interventions in Patients with Gallbladder Stones: The Internist's View
Acute Biliary Pancreatitis
Systemic Litholysis with Bile Acids
Principles of Gallstone Dissolution with Chenodeoxycholic Acid, Ursodeoxycholic Acid, and the Combination of Both Bile Acids
Systemic Litholysis with Bile Acids: Ursodeoxycholic Acid
Combination Therapy of Chenodeoxycholic Acid and Ursodeoxycholic Acid
Results of an Index-Controlled Combination Therapy with Ursodeoxycholic and Chenodeoxycholic Acid
Extracorporeal Schock-Wave-Lithotripsy
Physical Basis of Lithotriptors
Extracorporeal Shock-Wave Lithotripsy of Gallstones
Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones
Piezoelectric Lithotripsy of Gallbladder Stones
BiliaryShock-Wave Lithotripsy: Experience of the First 3 Years in 612 Patients
Laser Lithotripsy
Laser Lithotripsy: Basic Physics
Laser Lithotripsy: Clinical Applications
Local Litholysis
Local Litholytic Agents: Dissolution of Cholesterol Biliary Tract Stones with Methyl tert-Butyl Ether
Local Litholysis of Calcified Pigment Stones
Local Litholysis of Intrahepatic Calculi
New Therapeutic Trends
Reduction of Biliary Cholesterol Saturation by Inhibition of Cholesterol Synthesis: New Therapeutic Consequences?
Gallstone Prevention by Alteration of Gallbladder Mucin Secretion via Prostaglandin Synthesis Inhibition
Gallstone Prevention After Successful Treatment
Intermittent Bile Acid Therapy as an Alternative Therapeutic Strategy.