Results of Combined Biliary Drainage and Cholecystokinin Cholecystography in 81 Patients with Normal Oral Cholecystograms

Overview

Journal Ann Surg

Specialty General Surgery

Date 1982 Dec 1

PMID 7149812

Citations 6

Authors

M J Burnstein

K P VASSAL

S M Strasberg

Affiliations

Soon will be listed here.

Abstract

Combined biliary drainage-cholecystokinin cholecystography (BD-CC) was evaluated in 81 patients with pain indistinguishable from biliary colic, but normal conventional diagnostic tests. The test was performed using a new technique of intubation and aspiration, with a steerable catheter and sump duodenal tube. Both positive and negative groups were followed. One third of patients had positive tests, and almost all had pathologic gallbladders, and a symptomatic outcome equal to that obtained by cholecystectomy for cholelithiasis diagnosed by conventional means. Some patients with severe pain had cholecystectomy despite a negative report. Pathologic findings were significantly fewer, and symptomatic outcome less satisfactory but sufficiently good to suggest that painful functional gallbladder abnormalities, not amenable to diagnosis by BD-CC exist. Hypercontraction was found to be a reliable index of gallbladder pathology. A false bilirubin precipitate was identified in some patients; this precipitate may be recognized by microscopy and pH testing. This finding should reduce false-positives in BD-CC.

Citing Articles

Wang H, Portincasa P, Liu M, Tso P, Wang D Liver Res. 2021; 2(4):186-199.

PMID: 34367716 PMC: 8341470. DOI: 10.1016/j.livres.2018.10.001.

Quantitative cholescintigraphy and bile abnormalities in patients with acalculous biliary pain.

Ponce J, Pons V, Sopena R, Garrigues V, Ponce M, Ortiz V Eur J Nucl Med Mol Imaging. 2004; 31(8):1160-5.

PMID: 15029457 DOI: 10.1007/s00259-004-1464-6.

Biliary dyskinesia: a study of more than 200 patients and review of the literature.

Canfield A, Hetz S, Schriver J, Servis H, Hovenga T, Cirangle P J Gastrointest Surg. 1998; 2(5):443-8.

PMID: 9843604 DOI: 10.1016/s1091-255x(98)80035-8.

Nucleation of cholesterol monohydrate crystals from hepatic and gall-bladder bile of patients with cholesterol gall stones.

Gollish S, Burnstein M, Ilson R, Petrunka C, Strasberg S Gut. 1983; 24(9):836-44.

PMID: 6884818 PMC: 1420078. DOI: 10.1136/gut.24.9.836.

Cholesterolosis: a physical cause of "functional" disorder.

Jacyna M, Bouchier I Br Med J (Clin Res Ed). 1987; 295(6599):619-20.

PMID: 3117259 PMC: 1257755. DOI: 10.1136/bmj.295.6599.619.

References

Foss D, LAING R . Detection of gallbladder disease in patients with normal oral cholecystograms. Results using a simplified biliary drainage technique. Am J Dig Dis. 1977; 22(8):685-9. DOI: 10.1007/BF01078347. View

Freeman J, COHEN W, Denbesten L . Cholecystokinin cholangiography and analysis of duodenal bile in the investigation of pain in the right upper quadrant of the abdomen without gallstones. Surg Gynecol Obstet. 1975; 140(3):371-6. View

Goldstein F, Grunt R, Margulies M . Gholecystokinin cholecystography in the differential diagnosis of acalculous gallbladder disease. Am J Dig Dis. 1974; 19(9):835-49. DOI: 10.1007/BF01071944. View

Nathan M, Newman A, Murray D, Camponovo R . Cholecystokinin cholecystography. A four year evaluation. Am J Roentgenol Radium Ther Nucl Med. 1970; 110(2):240-51. DOI: 10.2214/ajr.110.2.240. View

Leopold G, AMBERG J, Gosink B, Mittelstaedt C . Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques. Radiology. 1976; 121(2):445-8. DOI: 10.1148/121.2.445. View

Humphries T, Cloutier C . The value of duodenal bile examination in the evaluation of persistent pain in the upper part of the abdomen. Surg Gynecol Obstet. 1978; 147(2):177-81. View

COZZOLINO H, Goldstein F, GREENING R, Wirts C . THE CYSTIC DUCT SYNDROME. JAMA. 1963; 185:920-4. DOI: 10.1001/jama.1963.03060120030017. View

FOTOPOULOS J, CRAMPTON A . ADENOMYOMATOSIS OF THE GALLBLADDER. Med Clin North Am. 1964; 48:9-36. DOI: 10.1016/s0025-7125(16)33484-8. View

JORPES J, Mutt V . The gastrointestinal hormones, secretin and cholecystokinin-pancreozymin. Ann Intern Med. 1961; 55:395-405. DOI: 10.7326/0003-4819-55-3-395. View

10.

Bartrum Jr R, Crow H, Foote S . Ultrasonic and radiographic cholecystography. N Engl J Med. 1977; 296(10):538-41. DOI: 10.1056/NEJM197703102961004. View

11.

JUNIPER Jr K, BURSON Jr E . Biliary tract studies. II. The significance of biliary crystals. Gastroenterology. 1957; 32(2):175-208; discussion, 208-11. View

12.

Stadalnik R, Matolo N . Radionuclide imaging of the biliary tree. Surg Clin North Am. 1981; 61(4):827-42. DOI: 10.1016/s0039-6109(16)42482-5. View

13.

Sigman H, Goldberg N, Niloff P, Lachance C . Use of biliary drainage in diagnosis of biliary tract disease. Am J Gastroenterol. 1977; 67(5):439-43. View

14.

McFarland J, Currin J . Cholecystokinin and the cystic duct syndrome. Clinical experience in a community hospital. Am J Gastroenterol. 1969; 52(6):515-22. View

15.

NESCHIS M, King M, Murphy R . Cholecystokinin cholecystography in the diagnosis of acalculous extrahepatic biliary tract disorders. Am J Gastroenterol. 1978; 70(6):593-9. View

16.

Porterfield G, Cheung L, Berenson M . Detection of occult gallbladder disease by duodenal drainage. Am J Surg. 1977; 134(6):702-4. DOI: 10.1016/0002-9610(77)90306-3. View