Oragrafin, a new cholecystographic medium: a double-blind comparison with Telepaque.

Abstract

Several good cholecystographic media are now in use but, since each of them has some disadvantages, the search for new and improved preparations continues. Criteria used to define a good cholecystographic agent have been suggested by a number of authors (11, 12). Prerequisites for an optimal medium are as follows: (a) low toxicity with minimal side reactions; (b) rapid absorption from the gastrointestinal tract and excretion by the liver; (c) prompt elimination; (d) selective concentration of the agent in the gallbladder; (e) preferential renal excretion to decrease the amount of medium in the intestine; (f) opacification sufficient to insure diagnostic accuracy but not obscure detail within the gallbladder. In addition to these, opacification of the extrahepatic biliary duct system would obviate the necessity of using the intravenous method, add considerably to the information obtained by the examination, and make the roentgen study of the biliary system a single procedure in which an oral contrast material could be used. Reports in the European literature indicate that Oragrafin, the agent used in the study to be reported here, is excreted by the liver in sufficient quantity to opacify the extrahepatic biliary ducts without concentration by the gallbladder (2–5, 8, 10). It is possible that this medium will therefore prove to be a satisfactory oral cholangiographic agent. Before attempting to use it to opacify ducts, however, we thought it best to compare its value in cholecystography with a medium with which we have had considerable experience. Manton (6), on the basis of a study of 100 patients, concluded that Biloptin (Oragrafin) was probably to be preferred over Telepaque. Oragrafin2 has been studied in a number of European centers. Chemically it is the sodium salt of B-3-dimethylaminomethyleneamino - 2,4,6 - triiodophenyl - propionic acid. It has an iodine content of 61.4 per cent. It is available in granules put up in capsules and in a water-soluble form. The latter, its calcium salt, is supplied as a powder and can be used in aqueous solution. When this medium is employed to opacify the ducts, a second dose is given on the morning of the examination in addition to the usual evening dose. A single dose in the morning followed by roentgen examination has also been used for duct visualization. Whiteside (16) has compared the results of common duct opacification obtained with Oragrafin with that obtained with the intravenous medium, Biligrafin (Cholografin), and found it to be inferior to the latter. Several authors, however, have achieved satisfactory common duct opacification with Oragrafin in a high percentage of cases, with a low incidence of side-effects and retained colonic residue. It is reportedly the best oral common duct opacifying agent now in use (2, 8,10). Norman and Saghatoleslami (9), however, have developed a method of opacifying the biliary duct system with Telepaque administered orally.