CLINICAL APPLICATION OF PHARMACOLOGICAL AND FUNCTIONAL EPCG

Abstract

The normal function of the gallbladder play a role of 'buffer', which make it difficult to visualize the intrahepatic bile ducts satisfactorily during EPCG. To demonstrate the intrahepatic bile ducts during EPCG, caerulein or CCK-PZ and morphine were injected, and the latter made sphincter of Oddi contract tightly and prevented the contrast medium from flowing back out of the orifice of the duodenal papilla. And they were called 'pharmacological EPCG'. Comparisons were made on three groups of the visualized intrahepatic bile ducts. The groups were: (1) 51 cases without any injection, (2) 14 cases with injection of caerulein or CCK-PZ and (3) 16 cases with injection of morphine. All cases had normal gallbladders and bile ducts. The best visualization of the intrahepatic bile ducts was obtained in group (3), the second-best visualization in group (2), the poorest visualization in group (1). Findings on the intrahepatic cholangiograms were investigated in 65 cases of liver diseases in which ducts beyond the fourth branches were demonstrated. Characteristic findings on the intrahepatic cholangiograms were present in some types of liver diseases. So, EPCG can be contributory to diagnose liver diseases when it demonstrates complete visualization of the intrahepatic bile ducts. Up to now, as for EPCG, the examiners have only paid attention to the morphological changes, but not to the functional changes of the biliary system. We considered that the examination of the function of the biliary system was important, too. Gallbladder contraction by ingestion of the egg yolk or injection of the caerulein was observed during EPCG. And it was called 'functional EPCG'. Even in the cases of hepatic failure or gallbladder diseases which showed nonvisualization of the gallbladder by oral cholecystography and intravenous cholangiography, the information of the function of the gallbladder could be obtained by this method because of direct approach. Furthermore, observations could be made on the change of the gallbladder neck and cystic duct more in detail by this method, in comparison to oral cholecystography and intravenous cholangiography. So, this method helps to diagnose and understand the mechanism of biliary dyskinesia well.