J.Jpn. Surg. Soc.. 88(1): 81-88, 1987

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Original article

EFFECT OF PROTEOLYTIC ENZYMES AND BILE SALTS COMBINED WITH EDTA 4Na ON DISSOLUTION OF CALCIUM BILIRUBINATE GALLSTONES

In vitro dissolution of the gallstones was studied in order to evaluate the effect of proteolytic enzyme (Pronase E) and bile acids (CA, CDCA, UDCA and TCA) on the dissolution of the calcium bilirubinate gallstones with ethylene diamine-tetraacetic acid (EDTA 4Na) solution. In this study, the slices and the whole concrement of the calcium bilirubinate gallstones were dissolved with an admixture of the chemical agents.
It was shown that a pretreatment with 0.5-1.0% solution of Pronase E made the slices susceptible to the dissolution with EDTA 4Na (1.0%). Although, the addition of Pronase E to an admixture of CA and EDTA 4Na did not increase the efficacy of the slices dissolution, it seemed to be effective in the dissolution of the whole concrement. Regarding to the effect of the bile acids on the slices dissolution, each bile acid was not significantly different from the others when it was used as a 25mM admixture with EDTA 4Na.
One hundred milimoles solution of TCA had 2-fold activity of a 25mM solution in the dissolution of both the slices and the whole concrement when it was used in combination with EDTA 4Na.
The results suggest that a pretreatment of the calcium bilirubinate gallstones with Pronase E is of great advantage in dissolution therapy. It is also suggested that TCA (100mM in EDTA 4Na), which can be applied in human beings without any serious side effect, is helpful in the treatment of calcium bilirubinate gallstones in clinical cases.

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