Introduction
An oral cholecystogram is an imaging test that has been used historically as the main method for the diagnosis of gallbladder abnormalities and to visualize the gallbladder. Currently, with the advent of modern imaging techniques like ultrasound and CT scans, the oral cholecystogram is rarely used. Still, they are in practice as they sometimes visualize the gallstones, which are not visualized through other modalities. The process mainly involves using a contrast agent followed by imaging to track the flow of the dye material into the biliary system. The test has maintained its relevance despite the emergence of newer advanced modalities with its advantages and insight into gallbladder pathology. They are easily accessible in various clinical settings and are relatively cost-effective compared to other imaging. This article intends to explore the diagnostic world of oral cholecystogram, its procedure, and the advantages and risks involved.
What Is the Procedure for an Oral Cholecystogram?
The patient is asked to take iodine-containing tablets (which may contain compounds like iopanoic acid or iocetamic acid) orally for one or two nights before the procedure. The patient is also advised to fast overnight before the test so that the gallbladder is filled with bile. The idea is that iodine is absorbed into the bloodstream and then removed by the liver, excreting it into the bile. The bile concentrates the iodine in the gallbladder. X-ray images are taken at intervals and in different positions to track the contrast material in the digestive system. The procedure may take several hours, involving multiple imaging in different positions. Iodine is dense and radiopaque, so it helps outline gallstones when they are present.
After the imaging, the radiologist receives and interprets the images. The structure and function of the gallbladder system are visualized and noted. Any abnormalities, such as gallstones or contractions, are identified and mentioned in the report.
What Are the Indications of Oral Cholecystogram?
Gallstones Detection: Gallstones are deposits seen in the gallbladder or bile ducts. They cause symptoms such as pain in the abdomen, nausea, and vomiting. Tests like oral cholecystograms can help confirm the diagnosis and give insight into the size and location of the stone.
Cholecystitis: Cholecystitis is a condition where there is inflammation of the gallbladder. They often present with gallstones and are accompanied by symptoms such as pain in the abdomen, fever, nausea, vomiting, and discomfort.
Biliary Colic: Patients repeatedly having episodes of severe pain in the abdomen, more commonly due to gallstone construction, might be experiencing biliary clc. In such cases, an oral cholecystogram is indicated to confirm the gallstone and plan further treatment.
Gallbladder Monitoring: The gallbladder function can be monitored by checking the contrast uptake and excretion ability.
Alternative to Ultrasound: In cases where ultrasound cannot be performed, such as abdominal scars or in obese individuals when the results are inconclusive, an oral cholecystogram can be used to assess the gallbladder function and the bile duct system.
Research: One use of this testing is research studies, which study and analyze gallbladder physiology and pathology.
Preoperative Evaluation: Before assigning certain abdominal surgeries involving the biliary tract and gallbladder, the surgeon may order an oral cholecystogram to assess the extent of the disease and gain a pictorial insight into the anatomy of the biliary system.
What Are the Potential Risks of Oral Cholecystogram?
The test is generally considered safe, but it carries many risks and considerations. Some of the potential risks include:
Allergy: Some individuals are allergic to the iodine in the contrast agent. This will trigger allergic reactions in the body. A careful history must be taken, and a sensitivity test must be performed on doubtful individuals.
Side Effects: The contrast agents can cause numerous side effects, such as nausea, vomiting, and abdominal pain in some individuals.
Radiation Exposure: This diagnostic procedure has a major risk of exposure to ionizing radiation, like other X-ray procedures. Therefore, this procedure is contraindicated for pregnant women and young children.
Other Tests Necessary: This test does not provide detailed information on biliary system abnormalities. It can only detect gallstones and the function of the gallbladder. When other abnormalities are suspected, other imaging tests may be necessary.
False Test Results: The bile ducts in this test cannot be seen on the x-ray as iodine does not get concentrated there. Therefore, if the gallstones are present in the ducts, they will go undetected. Also, if the cystic duct somehow has an obstruction, there is less chance of the contrast solution flowing into the gallbladder, thereby not showing in the image. Another possibility is that an inflamed gallbladder can interfere with the gallbladder's ability to concentrate on the contrast solution. All these will make the test fail to visualize the gallbladder.
What Are the Future Considerations for Oral Cholecystography?
Oral cholecystograms can be better for the patient and clinician by integrating them with advanced imaging modalities like endoscopic ultrasound and magnetic resonance cholangiopancreatography to provide more detailed information and make the diagnosis more accurate. There have been numerous attempts to bring out novel contrast agents that are safer and more acceptable to the patient. Also, efforts are made to reduce radiation exposure by using lower-dose X-ray techniques. There have also been attempts made to teach artificial intelligence algorithms to analyze oral cholecystogram images and help diagnose them more accurately, thereby improving patient outcomes to a great extent.
Conclusion
To conclude, the oral cholecystogram is a valuable asset in diagnosing gallbladder stones and evaluating the gallbladder's function. With the advent of newer imaging modalities like ultrasound and CT scans, the oral cholecystogram test is performed less often because of the risks involved. Still, it is prescribed and, in some cases, reveals stones not shown in ultrasonography. By understanding the procedure, indications, and risks involved in this procedure, the clinician and healthcare provider can make the best decision regarding gallbladder disease diagnosis and management.
