A new fractionated administration of telepaque for oral cholecystography

Kim, C J; Bahk, Y H; Banf, C Y; Kim, J W

Abstract

ORAL CHOLECYSTOGRAPHY is one of the most widely used diagnostic procedure. yet in a considerable number of thepatients, the gall bladder may not be visualized or is only very faintly opacified with contrast medium. Theschedule of the administration of the contrast medium typically starts from 9 PM after climination of fat mealfrom the meals prior to the administration. This time-honored schedule of administration has been in use withoutappropriate understanding of the mechanisms of the intestinal absorption, conjugation in the liver and excretioninto the biliary system of contrast material. It is, however, now very clear that the contrast medium must firstbe absorbed from the intestinal tract. The present study has been carried out to test the effect of fractionatedadministration of Telepaque on visualization of the gallbladder and on the incidence of the finding of conjugatedcontrast materials within the colon. Two hundred unselected consecutive patients were subjected to oralcholecystography employing conventional and fractionated administration of Telepaque, respectively. The new mathodconsisted of aking one tablet of Telepaque every hour starting at 3 PM the day before t he examination, instead oftaking the tablet every 5 min. starting at 9 PM. Radiographs taken in the next morning were evaluated according tothe grading method employed by Koehler and Kyaw. It is graded from 0 to 4+, 0 being non-visualization, 1+ beingpoor visualization, 2+ being fair visualization, 3+ being good visualization and 4+ being excellent visualization(Table 3). The present study revealed that there was a significant increase in the number of the radiographs withgood diagnostic quality when the fractionated method was used. It is also clear that more patients showedconjugated contrast medium when the fractionated method is used. This enhanced conjugation of contrast medium isutilized to increase the visibility of biliary tree by tomography when the gallbladder is not opacified.