The Indications for Duodenal Drainage: Its Relation to Cholecystography

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Since its clinical application by Lyon in 19191, the Meltzer-Lyon method of duodenal drainage has proved physiologically sound but its clinical value has been disputed. When cholecystography was introduced by Graham and his coworkers in 19242, interest in this procedure diverted attention from duodenal drainage for a number of years. During the past 14 years, however, the value and limitations of cholecystography have become established. Due to certain limitations of cholecystography, duodenal drainage is again being used by an increasing number of clinicians in conjunction with cholecystography and other roentgen examinations, each procedure giving findings complementary to the other.

In our experience cholecystography has proved the most important single diagnostic procedure pertaining to the biliary tract. The use of newer developments in technic3,4,5 has enhanced its accuracy. However, there are instances in which the gallbladder has been removed, where jaundice of a sufficient degree to contraindicate the use of cholecystography exists, and when both clinical and cholecystographic findings are indeterminate.

Although we do not use duodenal drainage routinely in the investigation of the upper gastro-intestinal tract, in recent years it has been employed in an increasing number of cases and it has given important information which could be obtained in no other way.

In this communication certain features relative to an appraisal of both cholecystography and duodenal drainage will be mentioned, and the indications for duodenal drainage, according to our experience, will be presented.

In attempting to relax the sphincter of Oddi and promote drainage of bile, it should be. . .



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