Results of combined biliary drainage and cholecystokinin cholecystography in 81 patients with normal oral cholecystograms.
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.
D000328:Adult; D000368:Aged; D001646:Bile / Q000032:analysis*; D001663:Bilirubin / Q000032:analysis; D011232:Chemical Precipitation; D002765:Cholecystography / Q000379:methods*; D002766:Cholecystokinin; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000503:physiopathology; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D013396:Suction / Q000379:methods*
D002766:Cholecystokinin; D001663:Bilirubin