Fortschr. Röntgenstr. 129,4
P. Mäkeläu. Mitarb.
Fortschr. Röntgenstr. 129, 4 (1978) 418-420
Effect of Glucagon on the double contrast examination of the Stomach and Duodenum By P. Mäkelä, I. Rossi and M. Kormano Department of Diagnostic Radiology, University Central Hospital (Director: Prof. P. Virtama), Turku, Finland.
We have evaluated the effect of glucagon on the quality of visualization of the gastric and duodenal mucosa in a routine tubeless double contrast examination of 418 consecutive cases. The patients received either 0.5 mg i.v., 0.25 mg i.v. or no glucagon, at random. The use of glucagon improved the visualization of areae gastricae and produced slightly fewer gas bubbles in the stomach. Visualization of the duodenum was significantly improved. The frequency of adequate hypotonic duodenography was related to the dose of glucagon, with 0.5 mg it was achieved in 49% of cases. No side-effects ascribable to glucagon were observed. The routine use of a small i.v. dose of glucagon in double contrast studies is recommended.
Introduction The diagnostic superiority of double contrast examination of
the stomach has been well documented by a multitude of studies (5, 10, 17). For obvious reasons this mehtod should be used as a primary routine rather than as a complementary or control technique. Many authors use pharmacologic relaxa-
tion of the stomach and duodenum either as a routine or complementary technique to improve the diagnostic potential (9, 13, .15, 16). The drug which at present is most appropri-
Die Wirkung von Glukagon auf die Doppelkontrastdarstellung des Magens und Zwölffingerdarms Die Verfasser untersuchten die Wirkung von Glukagon auf die Qualität der röntgenographischen Darstellung der Magen- und Zwölffingerdarmschleimhaut bei schlauchloser routinemäßiger Doppelkontrastuntersuchung in 418 Fällen. Die Patienten erhielten willkürlich entweder 0,5 mg i.v., 0,25 mg iv., oder kein Glukagon. Die Anwendung von Glukagon verbesserte die Darstellung der gastrischen Gebiete bei leicht verstärkter Gasblasenbildung im Magen. Die Darstellung des Zwölffingerdarms wurde erheblich verbessert. Die Häufigkeit zufriedenstellender Zwölffingerdarmdarstellung stand mit der Glukagondosis in Zusammenhang und wurde bei dem Dosierungsspiegel von 0,5 mg in 49% der Fälle erreicht. Es wurden keine Nebenwirkungen beobachtet, die auf das Glukagon zurückgeführt werden konnten. Die routinemäßige Anwendung einer geringen intravenösen Glukagondosis wird bei Doppelkontrastdarstellungen empfohlen.
macoradiography on the final success of the method should be evaluated. The present investigation was performed in order to evaluate the effect of glucagon on the quality of visualization of gastric
and duodenal mucosa in a standardized routine double contrast examination.
Materials and methods Patients
ately used in radiodiagnosis of the stomach and bowel is
Altogether 418 unselected consecutive adult patients were
glucagon, which has a hypotonic and hypomotile effect com-
studied at random. All the studies were performed by the same team and using the same technique and equipment. No essen-
parable to propantheline bromide, but a shorter duration of action and practically no side-effects in small doses (2, 8). While double contrast examination of the upper gastrointesti-
nal tract is being widely implemented, the relative effect of various technical factors like contrast media and phar0340-1618/78
tial pathology was found in 286 examinations, while in 132 cases tumor, ulcer or other significant pathology was revealed. The distribution of pathologic findings in various patient groups was even.
1032-0418 $05.00 © 1978 Georglhiemepublishers
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
418
Fortschr. Röntgenstr. 129, 4
Effect of Glucagon on the double contrast examination of the Stomach and Duodenum Table 1
Gaseous distention of the stomach in relation to the dose of
Table 2
419
Gas bubbles disturbing the double contrast examination of
the stomach in relation to the dose of glucagon (inadequate =
glucagon
bubbles disturbed interpretation, adequate = bubbles few if any, no Inadequate
Adequate
(n)
%
(n)
%
025 mg iv.
(32)
17
(158)
83
mg iv.
(24)
21
(92)
79
All glucagonized together (56) No glucagon (29)
18
(250)
82
26
(83)
74
0.50
diagnostic difficulty)
no statistical difference
p < 0.10 no significant difference
Double contrast examination Gastric secretions, if any, were not removed. The patient was placed on the fluoroscopic table and an intravenous injection of glucagon was given as follows: 112 patients were given no glucagon, neither a placebo injection. 190 and 116 patients
received a dose of 0.25 mg and 0.5 mg Glucagon Novo®, respectively, into the cubital vein. Thereafter the patient was given effervescent powder (mixture of sodium tartrate and sodium bicarbonate as fine powder, 2 g of each) which they swallowed with the help of 10-20 ml of distilled water and 1.5
ml of sodium polysiloxane (50 mg/mI, Lääke Qy, Turku
Dose of glucagon
Inadequate
Adequate
(n)
%
(n)
%
0.25 mg iv.
(19)
10
(171)
90
0.50 mg iv.
(11)
9
(105)
91
no statistical difference
(20)
10
(276)
90
p < 0.05
(20)
18
(92)
82
All glucagonized
together No glucagon
more after glucagon. Failure to swallow all of the effervescent powder or immediate regurgitation of gas after swallowing were the most frequent causes of inadequate gas distention. The number of disturbing gas bubbles in gastric contents tended to be somewhat lower with glucagon (Table 2). Likewise, good visualization of areae gastricae was more frequent after glucagon relaxation than without glucagon, independent of dose (Table 3).
Duodenum In contrast to the stomach, where improvement of the radiographic quality was relatively small, the radiographic visualiza-
research preparation) suspension. After 2 minutes 100 ml of EZ-pague HD3 suspension (EZM Company, New York, USA) was given and the study performed according to the principles presented by Shirakabe (17) and Laufer(9) with minor modifi-
tion of duodenum was substantially improved by glucagon injection in a high percentage of examinations (Table 4).
cations.
molytic drugs. After glucagon injection the duodenal sweep was always much wider than without relaxation, the radiographic result was frequently comparable to that obtained with hypotonic intubated duodenography. Injection of 0.25 mg of glucagon iv. almost doubled the success rate. With the dose of
The resulting double contrast radiographs were evaluated by
radiologists. The degree of gaseous distention, the number of gas bubbles and the visualization of the areae three
gastricae in the stomach were evaluated. Good radiographic result was regarded as adequate while poor or fair result as inadequate. Similarly, the resulting duodenal radiographs were given a score of adequate if gaseous distention and mucosal coating were both good, corresponding that of conventional hypotonic duodenography, the score being otherwise inadequate. In case of poor duodenal bulb visualization, later complementary films were taken with single contrast technique and
compression. They were not included in the evaluation here. Statistical analysis of the scores was performed using the X2test and Yate's correction for continuity.
Results General
Preliminary trials showed that doses of I or 2 mg glucagon, either intramuscularly or intravenously frequently caused sideeffects, mainly nausea and headache. Such side-effects were not reported by any patient of the present series with either 0.25 mg or 0.50 mg of glucagon. Rapid expansion of the stomach due to effervescent powder, however, frequently caused some
discomfort. The average duration of the examination was slightly longer when glucagon was given, since progression of contrast suspension was slower in hypotonized duodenum. Due to the temporary nature of glucagon relaxation, there was no difficulty in obtaining conventional spots on duodenal bulb within 15-20 min after the injection of glucagon. Stomach
Sufficient amount of gas in the stomach, as estimated visually, was obtained in approximately the same percentage of patients in all groups (Table 1), although the stomach regularly dilated
Double contrast visualization of duodenum with good gaseous distention of the sweep was relatively infrequent without spas-
0.50 mg glucagon good hypotonic duodenograms were obtained in a still higher percentage (49%).
Discussion The major improvement of diagnostic capacity, provided by the double contrast method depends on detailed macroscopic visualization of the anatomy, since very few physiological abnormalities can be reliably delineated by radiography (8). Mucosal visualization depends on its physiologic status and the technique of the study. The modern contrast suspensions
are able to adhere the gastric wall even under suboptimal conditions. Our recent comparative study showed the superiority of a high-density contrast suspension, which also was used here, in the demonstration of the mucosal detail of the stomach (7). The results of the presented study, based on technical evaluation, show that the use of glucagon-induced relaxation in the double contrast examination significantly improves the visuali-
zation of duodenal anatomy and it seems to improve the chance of adequate demonstration of gastric mucosa to some extent, having no obvious harmful technical influence. Temporary inhibition of physiologic movements obviously improve
the resolution of the radiographs. Relaxation of gut wall also helps gas distention and should improve the success rate of tubeless double contrast method, an approach widely applied in the hypotonic duodenography. Hypotonic duodenography results as an improved diagnosis of the lesions in duodenum
and neighboring organs (1, 2, 3, 4, 12, 14) which also emphasizes the importance of good morphologic detail over functional information.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Dose of glucagon
P. Màkelä u. Mitarb.: Effect of Glucagon on the double contrast examination.
Fortschr. Röntgenstr. 129, 4
Quality of double contrast duodenography in relation to the
Table 3 Visualization of areae gastricae in relation to the dose of
Table 4
glu cago n
dose of glucagon
Dose of glucagon
Inadequate %
Adequate
(n)
(n)
0.25 mg i.v.
(41)
22
(149) 78
0.50 mg i.v.
(26)
22
(90)
78
All glucagonized (67) together (40) No giucagon
22
(239)
78
36
(72)
64
%
Dose of glucagon
Inadequate
Adequate
(n)
(n)
%
0.25 mg iv. 0.50 mg i.v.
(120) 63
(70)
37
(59)
51
(57)
49
(179)
58 78
(127)
42
(25)
22
%
p < 0.05
All glucagonized p < 0.01
together No glucagon
(87)
p < 0.001
In addition to the technical improvement, pharmacoradiographic relaxation of the gastric and duodenal wall is a diag-
Literatur
nostic measure by itself. In our experience, a linitis plastica or a
(1) Ayre-Smith, G., S. Bank, R. E.
Laufer, L: A simple method for routine double contrast study of the
Kottler: Glucagon as a duodenal relaxant in tubeless and intubated duode-
upper gastrointestinal tract. Radiology 117 (1975) 513
nography. S. Afr. Med. J 49 (1975)
(10) Laufer, L.: Assesment of the accu-
subtle pancreatic expansion may escape detection even in a technically acceptable double contrast study unless a hypotonic agent is used. It therefore further lustifles the use a relaxing agent in double contrast studies. The radiological literature on glucagon in upper gastrointestinal tract examinations is still limited and its influence on the technical success and the diagnostic potential of the double contrast study has not been evaluated in large materials. The relatively high cost of glucagon has also inhibited its generalized use (11, 16). Even a small dose is effective (8) and will therefore help to cut the role of the cost factor. Substantial diagnostic advantage is achieved by the technical success of the examination with the help of glucagon as pointed out in recent literature (6). Contraindications for the use of glucagon are rare, but potential allergic reactions have depressed the enthusiasm for its use (11). Side-effects occur with doses of 1 mg or more. Over 1600
consecutive doses of 0.5 or 0.25 mg of glucagon have been given in our department, often twice or more to the same patient, over a period of 18 months. We have observed a very low risk of allergic reactions, since we have encountered only one case of mild rash, when a patient received a third glucagon injection in a GI examination. Allergic reactions seem to be less frequent and milder than for example reactions to Patent Blue
dye in lymphography (2% in our hospital). Whether hypersensitivity reactions will become more frequent following extensive use of glucagon remains to be established. At present we consider the routine administration of a small intravenous dose of glucagon as an essential part of a proper double contrast study of the stomach and duodenum. Its use makes the special hypotonic duodenography unnecessary in most cases and improves the diagnostic potential also in the stomach without significant side-effects.
ference to glucagon. Br. J. Radiol. 48 (1975) 691
12) Bertrand, G., W. G. Linscheer, K. L. Raheia, R. E. Woods: Double-blind
racy of double contrast gastroduodenal radiology. Gastroenterology 71 (1976) 874
evaluation of glucagon and propan-
(11)
theline bromide (Pro-Banthinel for hypotonic duodenography. Amer. J. Roentgenol. 128 (1977) 197 Carsen, G. M., N. Finby: Hypoto-
498
140
nie duodenography with glucagon. Radiology 118 (1976) 529 Chernish, S. M., R. E. Miller, B. D.
Rosenak, N. E. Scholz: Hypotonic duodenography with the use of glucagon. Gastroenterology 63 (1972) 392
(S) Dekker, W., J. O. Op den Orth: Early gastric cancer. Radiologia Clin. 46 (1977) 115
Gold, R. P., W. B. Seaman: The primary double-contrast examination of the postoperative stomach. Radiology 124 (1977) 297
Maeder, H-V., H.
F.
Fuchs:
Pharmakoradiographie des Gastroin. testinaltraktes. Radiologe 16 (1976) (12) Miller, R. E., S. M. Chernish, J. Skucas, B. D. Rosenak, B. E. Rodda: Hypotonie roentgenography with glu. cagon. Amer. J. Roentgenol. 121 (1974) 264
(13) Miller, R. E.: The air-contrast stomach examination: an overview. Radiology 117 (1976) 743 (14) Novak, D., P. Probst: Anwendung von Glucagon zur hypotonen Duodenographie. Dtsch. med. Wschr. 98 (1973) 2352 (15) Novak, D., J. Weber: Gegenwar-
Kormano, M., P. Mäkelä, 1. Rossi: Visualization of the areae gasticae in a double contrast examination - depen-
tiger Stand der Pharmakoradiologie des Magen-Darm-Traktes. Radiologe 16 (1976) 504 (16) Saxton, H. M.: Radiology now. Starting the double contrast barium
dence on the contrast medium. RöFo 128 (1978) 52 Kreel, L.: Pharmaco-radiology in barium examinations with special re-
meal. Br. J. Radiol. SO (1977) 610 (17) Shirakabe, l-I.: Double contrast studies of the stomach. Thieme, Stuttgart, 1972
Dr. med. Pekka Mákelä Dr. med. ilpo Rossi Prof. Dr. med. Martti Kormano Department of Diagnostic Radiology University Central Hospital 20520 Turku 52, Finland
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
420
P. Mäkeläu. Mitarb.
Fortschr. Röntgenstr. 129, 4 (1978) 418-420
Effect of Glucagon on the double contrast examination of the Stomach and Duodenum By P. Mäkelä, I. Rossi and M. Kormano Department of Diagnostic Radiology, University Central Hospital (Director: Prof. P. Virtama), Turku, Finland.
We have evaluated the effect of glucagon on the quality of visualization of the gastric and duodenal mucosa in a routine tubeless double contrast examination of 418 consecutive cases. The patients received either 0.5 mg i.v., 0.25 mg i.v. or no glucagon, at random. The use of glucagon improved the visualization of areae gastricae and produced slightly fewer gas bubbles in the stomach. Visualization of the duodenum was significantly improved. The frequency of adequate hypotonic duodenography was related to the dose of glucagon, with 0.5 mg it was achieved in 49% of cases. No side-effects ascribable to glucagon were observed. The routine use of a small i.v. dose of glucagon in double contrast studies is recommended.
Introduction The diagnostic superiority of double contrast examination of
the stomach has been well documented by a multitude of studies (5, 10, 17). For obvious reasons this mehtod should be used as a primary routine rather than as a complementary or control technique. Many authors use pharmacologic relaxa-
tion of the stomach and duodenum either as a routine or complementary technique to improve the diagnostic potential (9, 13, .15, 16). The drug which at present is most appropri-
Die Wirkung von Glukagon auf die Doppelkontrastdarstellung des Magens und Zwölffingerdarms Die Verfasser untersuchten die Wirkung von Glukagon auf die Qualität der röntgenographischen Darstellung der Magen- und Zwölffingerdarmschleimhaut bei schlauchloser routinemäßiger Doppelkontrastuntersuchung in 418 Fällen. Die Patienten erhielten willkürlich entweder 0,5 mg i.v., 0,25 mg iv., oder kein Glukagon. Die Anwendung von Glukagon verbesserte die Darstellung der gastrischen Gebiete bei leicht verstärkter Gasblasenbildung im Magen. Die Darstellung des Zwölffingerdarms wurde erheblich verbessert. Die Häufigkeit zufriedenstellender Zwölffingerdarmdarstellung stand mit der Glukagondosis in Zusammenhang und wurde bei dem Dosierungsspiegel von 0,5 mg in 49% der Fälle erreicht. Es wurden keine Nebenwirkungen beobachtet, die auf das Glukagon zurückgeführt werden konnten. Die routinemäßige Anwendung einer geringen intravenösen Glukagondosis wird bei Doppelkontrastdarstellungen empfohlen.
macoradiography on the final success of the method should be evaluated. The present investigation was performed in order to evaluate the effect of glucagon on the quality of visualization of gastric
and duodenal mucosa in a standardized routine double contrast examination.
Materials and methods Patients
ately used in radiodiagnosis of the stomach and bowel is
Altogether 418 unselected consecutive adult patients were
glucagon, which has a hypotonic and hypomotile effect com-
studied at random. All the studies were performed by the same team and using the same technique and equipment. No essen-
parable to propantheline bromide, but a shorter duration of action and practically no side-effects in small doses (2, 8). While double contrast examination of the upper gastrointesti-
nal tract is being widely implemented, the relative effect of various technical factors like contrast media and phar0340-1618/78
tial pathology was found in 286 examinations, while in 132 cases tumor, ulcer or other significant pathology was revealed. The distribution of pathologic findings in various patient groups was even.
1032-0418 $05.00 © 1978 Georglhiemepublishers
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
418
Fortschr. Röntgenstr. 129, 4
Effect of Glucagon on the double contrast examination of the Stomach and Duodenum Table 1
Gaseous distention of the stomach in relation to the dose of
Table 2
419
Gas bubbles disturbing the double contrast examination of
the stomach in relation to the dose of glucagon (inadequate =
glucagon
bubbles disturbed interpretation, adequate = bubbles few if any, no Inadequate
Adequate
(n)
%
(n)
%
025 mg iv.
(32)
17
(158)
83
mg iv.
(24)
21
(92)
79
All glucagonized together (56) No glucagon (29)
18
(250)
82
26
(83)
74
0.50
diagnostic difficulty)
no statistical difference
p < 0.10 no significant difference
Double contrast examination Gastric secretions, if any, were not removed. The patient was placed on the fluoroscopic table and an intravenous injection of glucagon was given as follows: 112 patients were given no glucagon, neither a placebo injection. 190 and 116 patients
received a dose of 0.25 mg and 0.5 mg Glucagon Novo®, respectively, into the cubital vein. Thereafter the patient was given effervescent powder (mixture of sodium tartrate and sodium bicarbonate as fine powder, 2 g of each) which they swallowed with the help of 10-20 ml of distilled water and 1.5
ml of sodium polysiloxane (50 mg/mI, Lääke Qy, Turku
Dose of glucagon
Inadequate
Adequate
(n)
%
(n)
%
0.25 mg iv.
(19)
10
(171)
90
0.50 mg iv.
(11)
9
(105)
91
no statistical difference
(20)
10
(276)
90
p < 0.05
(20)
18
(92)
82
All glucagonized
together No glucagon
more after glucagon. Failure to swallow all of the effervescent powder or immediate regurgitation of gas after swallowing were the most frequent causes of inadequate gas distention. The number of disturbing gas bubbles in gastric contents tended to be somewhat lower with glucagon (Table 2). Likewise, good visualization of areae gastricae was more frequent after glucagon relaxation than without glucagon, independent of dose (Table 3).
Duodenum In contrast to the stomach, where improvement of the radiographic quality was relatively small, the radiographic visualiza-
research preparation) suspension. After 2 minutes 100 ml of EZ-pague HD3 suspension (EZM Company, New York, USA) was given and the study performed according to the principles presented by Shirakabe (17) and Laufer(9) with minor modifi-
tion of duodenum was substantially improved by glucagon injection in a high percentage of examinations (Table 4).
cations.
molytic drugs. After glucagon injection the duodenal sweep was always much wider than without relaxation, the radiographic result was frequently comparable to that obtained with hypotonic intubated duodenography. Injection of 0.25 mg of glucagon iv. almost doubled the success rate. With the dose of
The resulting double contrast radiographs were evaluated by
radiologists. The degree of gaseous distention, the number of gas bubbles and the visualization of the areae three
gastricae in the stomach were evaluated. Good radiographic result was regarded as adequate while poor or fair result as inadequate. Similarly, the resulting duodenal radiographs were given a score of adequate if gaseous distention and mucosal coating were both good, corresponding that of conventional hypotonic duodenography, the score being otherwise inadequate. In case of poor duodenal bulb visualization, later complementary films were taken with single contrast technique and
compression. They were not included in the evaluation here. Statistical analysis of the scores was performed using the X2test and Yate's correction for continuity.
Results General
Preliminary trials showed that doses of I or 2 mg glucagon, either intramuscularly or intravenously frequently caused sideeffects, mainly nausea and headache. Such side-effects were not reported by any patient of the present series with either 0.25 mg or 0.50 mg of glucagon. Rapid expansion of the stomach due to effervescent powder, however, frequently caused some
discomfort. The average duration of the examination was slightly longer when glucagon was given, since progression of contrast suspension was slower in hypotonized duodenum. Due to the temporary nature of glucagon relaxation, there was no difficulty in obtaining conventional spots on duodenal bulb within 15-20 min after the injection of glucagon. Stomach
Sufficient amount of gas in the stomach, as estimated visually, was obtained in approximately the same percentage of patients in all groups (Table 1), although the stomach regularly dilated
Double contrast visualization of duodenum with good gaseous distention of the sweep was relatively infrequent without spas-
0.50 mg glucagon good hypotonic duodenograms were obtained in a still higher percentage (49%).
Discussion The major improvement of diagnostic capacity, provided by the double contrast method depends on detailed macroscopic visualization of the anatomy, since very few physiological abnormalities can be reliably delineated by radiography (8). Mucosal visualization depends on its physiologic status and the technique of the study. The modern contrast suspensions
are able to adhere the gastric wall even under suboptimal conditions. Our recent comparative study showed the superiority of a high-density contrast suspension, which also was used here, in the demonstration of the mucosal detail of the stomach (7). The results of the presented study, based on technical evaluation, show that the use of glucagon-induced relaxation in the double contrast examination significantly improves the visuali-
zation of duodenal anatomy and it seems to improve the chance of adequate demonstration of gastric mucosa to some extent, having no obvious harmful technical influence. Temporary inhibition of physiologic movements obviously improve
the resolution of the radiographs. Relaxation of gut wall also helps gas distention and should improve the success rate of tubeless double contrast method, an approach widely applied in the hypotonic duodenography. Hypotonic duodenography results as an improved diagnosis of the lesions in duodenum
and neighboring organs (1, 2, 3, 4, 12, 14) which also emphasizes the importance of good morphologic detail over functional information.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Dose of glucagon
P. Màkelä u. Mitarb.: Effect of Glucagon on the double contrast examination.
Fortschr. Röntgenstr. 129, 4
Quality of double contrast duodenography in relation to the
Table 3 Visualization of areae gastricae in relation to the dose of
Table 4
glu cago n
dose of glucagon
Dose of glucagon
Inadequate %
Adequate
(n)
(n)
0.25 mg i.v.
(41)
22
(149) 78
0.50 mg i.v.
(26)
22
(90)
78
All glucagonized (67) together (40) No giucagon
22
(239)
78
36
(72)
64
%
Dose of glucagon
Inadequate
Adequate
(n)
(n)
%
0.25 mg iv. 0.50 mg i.v.
(120) 63
(70)
37
(59)
51
(57)
49
(179)
58 78
(127)
42
(25)
22
%
p < 0.05
All glucagonized p < 0.01
together No glucagon
(87)
p < 0.001
In addition to the technical improvement, pharmacoradiographic relaxation of the gastric and duodenal wall is a diag-
Literatur
nostic measure by itself. In our experience, a linitis plastica or a
(1) Ayre-Smith, G., S. Bank, R. E.
Laufer, L: A simple method for routine double contrast study of the
Kottler: Glucagon as a duodenal relaxant in tubeless and intubated duode-
upper gastrointestinal tract. Radiology 117 (1975) 513
nography. S. Afr. Med. J 49 (1975)
(10) Laufer, L.: Assesment of the accu-
subtle pancreatic expansion may escape detection even in a technically acceptable double contrast study unless a hypotonic agent is used. It therefore further lustifles the use a relaxing agent in double contrast studies. The radiological literature on glucagon in upper gastrointestinal tract examinations is still limited and its influence on the technical success and the diagnostic potential of the double contrast study has not been evaluated in large materials. The relatively high cost of glucagon has also inhibited its generalized use (11, 16). Even a small dose is effective (8) and will therefore help to cut the role of the cost factor. Substantial diagnostic advantage is achieved by the technical success of the examination with the help of glucagon as pointed out in recent literature (6). Contraindications for the use of glucagon are rare, but potential allergic reactions have depressed the enthusiasm for its use (11). Side-effects occur with doses of 1 mg or more. Over 1600
consecutive doses of 0.5 or 0.25 mg of glucagon have been given in our department, often twice or more to the same patient, over a period of 18 months. We have observed a very low risk of allergic reactions, since we have encountered only one case of mild rash, when a patient received a third glucagon injection in a GI examination. Allergic reactions seem to be less frequent and milder than for example reactions to Patent Blue
dye in lymphography (2% in our hospital). Whether hypersensitivity reactions will become more frequent following extensive use of glucagon remains to be established. At present we consider the routine administration of a small intravenous dose of glucagon as an essential part of a proper double contrast study of the stomach and duodenum. Its use makes the special hypotonic duodenography unnecessary in most cases and improves the diagnostic potential also in the stomach without significant side-effects.
ference to glucagon. Br. J. Radiol. 48 (1975) 691
12) Bertrand, G., W. G. Linscheer, K. L. Raheia, R. E. Woods: Double-blind
racy of double contrast gastroduodenal radiology. Gastroenterology 71 (1976) 874
evaluation of glucagon and propan-
(11)
theline bromide (Pro-Banthinel for hypotonic duodenography. Amer. J. Roentgenol. 128 (1977) 197 Carsen, G. M., N. Finby: Hypoto-
498
140
nie duodenography with glucagon. Radiology 118 (1976) 529 Chernish, S. M., R. E. Miller, B. D.
Rosenak, N. E. Scholz: Hypotonic duodenography with the use of glucagon. Gastroenterology 63 (1972) 392
(S) Dekker, W., J. O. Op den Orth: Early gastric cancer. Radiologia Clin. 46 (1977) 115
Gold, R. P., W. B. Seaman: The primary double-contrast examination of the postoperative stomach. Radiology 124 (1977) 297
Maeder, H-V., H.
F.
Fuchs:
Pharmakoradiographie des Gastroin. testinaltraktes. Radiologe 16 (1976) (12) Miller, R. E., S. M. Chernish, J. Skucas, B. D. Rosenak, B. E. Rodda: Hypotonie roentgenography with glu. cagon. Amer. J. Roentgenol. 121 (1974) 264
(13) Miller, R. E.: The air-contrast stomach examination: an overview. Radiology 117 (1976) 743 (14) Novak, D., P. Probst: Anwendung von Glucagon zur hypotonen Duodenographie. Dtsch. med. Wschr. 98 (1973) 2352 (15) Novak, D., J. Weber: Gegenwar-
Kormano, M., P. Mäkelä, 1. Rossi: Visualization of the areae gasticae in a double contrast examination - depen-
tiger Stand der Pharmakoradiologie des Magen-Darm-Traktes. Radiologe 16 (1976) 504 (16) Saxton, H. M.: Radiology now. Starting the double contrast barium
dence on the contrast medium. RöFo 128 (1978) 52 Kreel, L.: Pharmaco-radiology in barium examinations with special re-
meal. Br. J. Radiol. SO (1977) 610 (17) Shirakabe, l-I.: Double contrast studies of the stomach. Thieme, Stuttgart, 1972
Dr. med. Pekka Mákelä Dr. med. ilpo Rossi Prof. Dr. med. Martti Kormano Department of Diagnostic Radiology University Central Hospital 20520 Turku 52, Finland
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