Cholecystokinetic cholecysto-choledochography

Park, H K; Bahk, Y W

Abstract

Oral cholecystography is a reliable and the most popular clinical examination. The examination is not suitablefor morphological study of hte gallbladder but also efficient in diagnosing acalculous cholecystitis and cysticduct syndrome and some ill defined functional disorders. For the functional evaluation of the gallbladder fat mealstimulation has been used traditionally. Recently, however, potent cholecystagogues called cholecystokinin(CCK)and ceruletide were introduced in the radiological examination of the gallbladeder stimulating acute interest inresearch of acalculous cholecystits and cystic duct syndrome. The present study has been undertaken to test bothexperimentally and clinically the cholecystokinetic effects of CCK and ceruletide. In addition, the study has beendesinged to test if pharmacological construction of the Oddi sphincter with morphine in animal and prostigmine inhuman subjects promotes visualization of the common bile duct and hopefully the common hepatic duct. Seven (7)mongrel dogs weighing 10kg were anesthesized with Pentothal sodium (20mg/kg body wt) in the evening allowed toswallow 2 g of lopanoic acid (Telpaque)per os. Twelve hours later in the next morning dogs were radiographed oftheir uper abdomen in LAO. Upon confirming optimal opacification of the GB 0.03ug/kg of CCK was injectedintravenously to each of the 7 mongrel dogs for the test of contraction -rate and contraction- time of thegallbladder. The same test was repeated after injecting 10mg/dog of morphine to constrict the Oddi sphincter. Theclinical materials consisted of 30 normal human subjects and 60 patients with biliary symptoms and signs. Thosewith abnormal upper gastrointestinal series and abnormal function tests of the pancrease were excluded from thematerials. We injected the same amount of CCK and studied the contraction rate and time with an emphasis onacalculous cholecystitis and cystic duct syndrome and some Ill-defined functional disorder. In addition, based onthe results of animal experiments, we made an attempt to enhance the visualization of the biliary tree byinjecting prostigmine and ceruletide in human subjects. The results were as follows; 1. The inital contraction ofthe gallbladder after intravenous CCK occurred between 1 and 2 minutes in dog. The mean maximum contraction of thegallbladder after intravenous CCK was 37.6±12.6% and occurred between 10 and 15 minutes in dog. The visualizationof extrahepatic bile ducts were enhanced after intravenous CCK added by morphine in 5 out of 7 dogs. 2. The meanmaximum contraction of the gallbladder after intravenous CCK was 38.8+023.7% in normal human controls and 29.5±18.4% in patients group, respectively. The difference was not significant statistically. A local spasm of thegallbladder after intravenous CCK was noted in 23% of patients group but none of normal controls. The differencewas significant statistically (p<0.05). Positive symptomatic response such as right upper quadrant and epigastricpain and cramps after intravenous CCK occurred in 33% of patients group but none of normal controls. Local spasmsand symptomatic response after intravenous CCK are helpful for correct diagnosis of pathologic gallbladder whichis 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 ductreflux occurred. 4. The visualization of extrahepatic bile ducts was enhanced after intramuscular ceruletide addedby prostigmine in 5 out of 10 normal human subjects.