Cholecystokinin Cholecystoqraphy

Abstract

CHOLE CYSTOKININ (CCK) , a hormone produced in the wall of the duodenum and proximal jejunum, causes the gallbladder to contract and the sphincter of Oddi to relax. Discovered in 1929 by Ivy and Oldberg (5), it has been refined several times by ]orpes and Mutt (7). Used in approximately one-quarter million cases without serious side-effects (8), CCK is nevertheless available only for investigative purposes under control of the Federal Drug Administration. The value of CCK in the diagnosis of cystic duct syndrome has been indicated by clinical investigators at Jefferson Medical College (2–4), who recently reported 13 cases encountered over an eight-year period. Their criteria for radiological interpretation of cystic duct syndrome were utilized in the beginning of our investigation of biliary pathology by means of CCK cholecystography (CCK-GB). These criteria included reproduction of the patient's right-upper-quadrant or epigastric pain after CCK, associated with less than 35 per cent contraction and poor filling of the common duct. It was soon found, however, that the cystic duct syndrome represented only a small part of the biliary pathology demonstrable by CCK-GB and, in addition, in a large number of these patients with a history of fatty-food intolerance associated with upper abdominal pain, their symptoms were not reproduced. We also found that many normal patients have less than 35 per cent and more than 80 per cent gallbladder evacuation in fifteen minutes. Material And Methods To be accepted for CCK-GB in this series, the patient must have had a history compatible with gallbladder disease and must have undergone one or more normal routine oral cholecystographies. On this basis 117 patients were accepted, and a total of 121 cholecystokinin cholecystographies were performed. In addition, 50 normal controls underwent CCK-GB. Each patient, prepared by ingested opaque gallbladder medium in double-dose quantity, received 75 Ivy dog units (3 mg) of CCK intravenously in ten to thirty seconds. Two patients experienced such severe right-upper-quadrant pain that nitroglycerin sublingually was required to relieve the symptoms; in both, cholecystitis was proved by surgery and microscopy. Except for this, no serious side-effects resulted from the CCK. Mild-to-moderate nausea occurred frequently, as did midabdominal and lower abdominal cramps, but there was neither emesis nor bowel incontinence. The feeling of warmth and/or flushing was noted by a small number of patients. All of these symptoms could be reduced by a longer injection time-most of the investigators have utilized an injection time of two minutes or more (1, 3, 4). After a preliminary film, radiographs were obtained at forty-five seconds, three minutes, five minutes, ten minutes, and fifteen minutes after injection of the CCK. Early in the study, thirty-second films also were taken, and, although many patients showed beginning gallbladder contraction, a large number did not exhibit any change.