Cholecystokinetic cholecysto-choledochography

Oral cholecystography is a reliable and the most popular clinical examination. The examinations is not suitable for morphological study of the gallbladder but also efficient in diagnosing acalculous cholecystitis and cystic duct syndrome and some ill defined functional disorders. For the functional evaluation of the gallbladder fat meal stimulation has been used traditionally. Recently, however, potent cholecystagogues called cholecystokinin (CCK) and ceruletide were introduced in the radiological examination of the gallbladder stimulating acute interest in research of acalculous cholecystitis and cystic duct syndrome. The present study has been undertaken to test both experimentally and clinically the cholecystokinetic effects of CCK and ceruletide. In addition, the study has been designed to test if pharmacological constriction of the Oddi sphincter with morphine in animal and prostigmine in human subjects promotes visualization of the common bile duct and hopefully the common hepatic duct. Seen (7) mongrel dogs weighing 10 kg were anesthesized with Pentothal sodium (20mg/kg body wt) in the evening allowed to swallow 2 g of lopanoic acid (Telepaque) per os. Twelve hours later in the next morning dogs were radiographed of their upper abdomen in LAO. Upon confirming optimal opacification of the GB 0.03 μ g/kg of CCK was injected intravenously to each of the 7 mongrel dogs for the test of contraction-rate and contraction-time of the gallbladder. The same test was repeated after injecting 10 mg/dog of morphine to strict the Oddi sphincter. The clinical materials consisted of 30 normal human subjects and 60 patients with biliary symptoms and signs. Those with abnormal upper gastrointestinal series and abnormal function tests of the pancreas were excluded from the materials. We injected the same amount of CCK and studied the contraction rate and time with an emphasis on acalculous cholecystitis and cystic duct syndrome and some ill-defined functional disorder. In addition, based on the results of animal experiments, we made an attempt to enhance the visualization of the biliary tree by injecting prostigmine and ceruletide in human subjects. The results were as follows; 1. The initial contraction of the gallbladder after intravenous CCK occurred between 1 and 2 minutes in dog. The mean maximum contraction of the gallbladder after intravenous CCK was 37.6 ± 12.6% and occurred between 10 and 15 minutes in dog. The visualization of extrahepatic bile ducts were enhanced after intravenous CCK added by morphine in 5 out of 7 dogs. 2. The mean maximum contraction of the gallbladder after intravenous CCK was 38.8 ± 23.7% in normal human controls and 29.5 ± 18.4% in patients group, respectively. The difference was not significant statistically. A local spasm of the gallbladder after intravenous CCK was noted in 23% of patients group but none of normal controls. The difference was significant statistically (ρ < 0.05). Positive symptomatic response such as right upper quadrant and epigastric pain and cramps after intravenous CCK occurred in 33% of patients group but none of normal controls. Local spasms and symptomatic response after intravenous CCK are helpful for correct diagnosis of pathologic gallbladder which is visualized normally. 3. The cystic duct and common bile duct were visualized after CCK in 73 and 78%, respectively, in controls and 69 and 74%, respectively, in patients. In 2 of 69 patients, definite hepatic duct reflux occurred. 4. The visualization of extrahepatic bile ducts was enhanced after intramuscular ceruletide added by prostigmine in 5 out of 10 normal human subjects