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December 3, 1955


Author Affiliations

New York

From the New York Polyclinic Medical School and Hospital.

JAMA. 1955;159(14):1350-1353. doi:10.1001/jama.1955.02960310014008

Visualization of the biliary tract in the natural or intact state has been realized in three major stages, each a milestone of progress in this field. The first stage came with the well-known work of Graham and Cole1 in 1924 and 1925, which resulted in visualization of the gallbladder. The second stage came about a quarter of a century later through the introduction of iopanoic acid (Telepaque). While investigating this compound as a cholecystographic medium, a high incidence of bile duct visualization was observed.2 With adequate gallbladder function, the cystic and common bile ducts are visualized in normalcy and the hepatic ducts by reflux.3 This occurs in 70% of patients examined, or in about 85% of patients whose gallbladders can be visualized. The incidence of duct visualization in the cholecystectomized patient is low and remains more or less unpredictable. The third stage came with the introduction of