The Effectiveness of Oral Cholecystagogues and Intravenous Cholecystokinin in Producing Bile Duct Visualization during Oral Cholecystography

Abstract

RADIOGRAPHIC examination of the extrahepatic biliary ducts by stimulation of the opacified gallbladder to evacuate its contents has received increasing attention as an integral part of oral cholecystography (1,3,8,11,13–16). The introduction of improved contrast media did much to create interest in the procedure due to the greater frequency with which the extrahepatic ductal system could be visualized (5, 7, 12). We have elected to study the effectiveness of various orally administered cholecystagogues in producing visualization of the bile ducts when the gallbladder has been opacified following the administration of iopanoic acid (Telepaque) by mouth. Our observations suggest that most normal ducts can be visualized in this way. It was not our object at this time to evaluate the abnormalities thus demonstrated. A group of patients were similarly studied after the intravenous administration of cholecystokinin2 (10). We wish in this report to consider only the relative usefulness of these several agents in bringing about visualization of the ducts by a simple (single film) examination adaptable to routine use. The findings in the ducts and the diagnostic information obtained by ductal visualization will form the subject of a separate communication. Materials and Methods A total of 2,904 patients were studied. Each had been given Telepaque in doses ranging from 1.5 to 6.0 gm. fourteen hours before the radiographic examination, with satisfactory opacification of the gallbladder for diagnostic evaluation. Of this group, 2,855 were given an oral cholecystagogue and 49 were given cholecystokinin intravenously. The oral cholecystagogues and the doses are shown in Table I. The cholecystokinin was administered intravenouslyover a two-minute period in a dose of 3.0 mg. dissolved in 20 c.c. of saline. Multiple serial films were taken at various intervals after the administration of the cholecystagogue (2, 6). On the basis of these, the time interval at which the bile ducts appeared to be most consistently visualized was selected to be adopted for a single post-evacuation film in subsequent cases. This period proved to be twenty minutes for the oral cholecystagogues. This differs somewhat from the optimum post-meal time specified by others, but the difference is not great. Shehadi (15), for example, found that biliary duct visualization was best obtained in from ten to fifteen minutes after oral administration of the fat meal, and Bercovitz et al. (1) reported ductal visualization to be most satisfactory at thirty minutes after the fat meal. The time interval that seemed most suitable for visualization of the extrahepatic ducts after the intravenous injection of cholecystokinin was eight minutes (2), although Jorpes and Mutt (10) have demonstrated that maximum gallbladder contraction occurs from ten to twenty minutes after injection of this preparation.