DIAGNOSTICS IN A SURGEON'S POCKET - THE HISTORY OF TELEPAQUE AND ORAL CHOLECYSTOGRAMS

Objectives: Prior to the 1930s, surgeons relied on knowledge of biliary symptomology to appropriately diagnosis biliary diseases. Cholecystography began in the 1930s, diagnostic studies that relied on x-rays and the administration of intravenous or oral iodine contrasts in patients suspected of biliary disease. It visualized biliary structures to assist surgeons in diagnosing diseases of the right upper quadrant. However, patients suffered side effects or had poor uptake and weak visualization from variable absorption. In 1952, iopanoic acid, also known as “Telepaque”, was introduced as a revolutionary oral contrast that worked better than prior compounds.

Methods: This presentation will describe a literature review of the development and implementation of this substance that provided practitioners additional diagnostic data regarding a patient's biliary anatomy.

Results: Telepaque was invented in 1949 by Lewis and Archer as an oral contrast for cholecystograms, diagnostic studies that involved consumption of said contrast agent followed by abdominal x-ray 12-24 hours after. The contrast agent would absorb in the small bowel, secrete into the liver’s canaliculi, and excrete into the biliary system, where it would travel to the gallbladder and duodenum. Clinically trialed and approved in the 1950s, this technique produced spectacular images of gallstones and created clear pictures of the entire biliary tree and gallbladder. Gallstones would over time absorb the contrast and those that appeared radiolucent would eventually opacify. The “rim sign” required 3-4 days of contrast administration before very bright, round gallstones could be seen on abdominal x-ray. This tool was helpful in ruling out or confirming the existence of many biliary disorders such as cholecystitis, choledocholithiasis, and obstructive biliary masses. The accuracy of this test in diagnosing biliary and gallbladder diseases was as high as 99 percent, making it a high yield diagnostic test. Telepaque produced almost no side effects, absorbed easily in the gut, and was found in the gallbladder as little as two hours after administration. It was a simple method of examining the biliary system and surgeons would carry tablets of the compound with them, conveniently administering this contrast to patients that would present with signs and symptoms of biliary diseases.

Conclusion: Surgeons today rely on many diagnostic tools in order to diagnosis biliary diseases. Ultrasound, computer tomography, magnetic resonance cholangiopancreatography, all represent advancements that made diagnosing biliary diseases simple. However, 70 years prior, surgeons were carrying a simple tablet that could be given to patients to safely, effectively, and conveniently diagnose of biliary disorders.