Further Studies on the Accuracy of Oral Cholocystography

This study is a summary of results in the first full year (1957) in which this drug was used, and was impressed by the fact that the accuracy of the diagnosis seemed to have little relationship to the medium employed for the roentgen study.

Abstract

In a recent communication (1), we discussed the degree of accuracy with which the presence or absence of pathologic changes in the gallbladder could be predicted by means of oral cholecystography. In that study all surgically proved chole-cystographic diagnoses at the Mayo Clinic in 1950 and 1955 were analyzed. These two years were chosen because of the different cholecystographic media employed: iodoalphionic acid (Priodax) in 1950 and iodophenoxic acid (Teridax) in 1955. In 1956, about midyear, we again changed our medium, and by September all patients were receiving iopanoic acid (Telepaque). This study is a summary of results in the first full year (1957) in which this drug was used. Procedure of Oral Cholecystography In this and in our previous study (1), we reviewed some 3,600 cholecystograms obtained in 1950, 1955, and 1957, and were impressed by the fact that the accuracy of the diagnosis seemed to have little relationship to the medium employed for the roentgen study. We are now firmly convinced that correct technical conduct of the examination, and continued vigilance and interest on the part of the radiologist and technician in this phase of the procedure, are indispensable if uniformly accurate results are to be expected. Scant attention has been paid to the actual technic of cholecystography in the literature of the past quarter century. For this reason we wish to recount, in some detail, the procedures which we employ. Preliminary Preparation of the Patient: Each patient is instructed to take four 0.5-gm. tablets of iopanoic acid during or shortly after an evening meal of the usual size, from which eggs and fats have been omitted. He eats nothing from then until after the x-ray examination has been made the next day, although he may drink water, black coffee, or clear tea. He is further advised not to take a laxative. It will be noted that the medium is ingested at a time when the stomach contains food. This, we believe, reduces to a minimum gastric irritation and unpleasant gastrointestinal side-effects attributable to the drug. After some trial of a high-fat meal on the evening preceding examination, we have concluded that more consistent results are obtained if fatty foods are eliminated from this meal. Roentgenographic Technic: The patient reports for examination approximately fourteen to sixteen hours after ingesting the medium; he is placed on the table in an easy posture with the head turned to one side. The arms are brought upward in a comfortable position, and a pillow is put under the ankles so that no weight is borne by the toes. A wide canvas binder is then firmly applied across the back at the level of the lower ribs. All of these procedures are designed to eliminate motion which may obscure roentgen evidence of stones or tumors.