Diagnostics in a Surgeon's Pocket-The History of Telepaque and Oral Cholecystograms

Biliary diseases such as cholelithiasis, choledocholithiasis, and cholecystitis all rely on imaging modalities to help make diagnoses. In modern times, ultrasound, computer tomography, and nuclear medicine scans help precisely visualize biliary and hepatic anatomy and pathology. The predecessor of these imaging modalities was the cholecystogram. This involved administration of contrast media that reliably had hepatic uptake and biliary excretion without causing significant side effects followed by radiograms of the abdomen. In the 1950s, iopanoic acid, known as telepaque, was a novel oral contrast, developed and clinical trialed for the use in diagnosing biliary pathology. A small, off-white colored powder available in a pill form, telepaque was readily available, conveniently administered by physicians at the bedside and produced beautiful cholangiograms within hours of administration. This paper briefly discusses the advent, physiology, and use of this novel compound that helped surgeons for many decades.