Gas-distension, double-contrast duodenography using the Scott-Harden gastroduodenal tube.

Hypotonic duodenography is a well recognized and well established procedure (Mallet-Guy and Jacquemet, 1963), by which the duodenal loop is outlined in a flaccid state. Variations of contour due to inherent duodenal movement are thus overcome. A constant pattern of the inner wall of the duodenal mucosa is obtained unobscured by overlying stomach, and even minor distortions become visible. Lesions of the pancreas and papilla of Vater affecting the duodenal loop can be distinguished from distortion due to peristalsis. 'Duodenographie hypotonique' (atonic duodenography) was performed using a double-contrast technique. To improve the technique it was considered imperative to produce marked distension of the duodenal loop as this would give the maximum amount of information as to alterations in the duodenal mucosa. It is considered that the distension of the duodenal lumen will force the inner wall of the duodenal loop against the juxtaposed pancreas, producing a constant appearance, and thus minor alteration due to early lesions of pancreatic tissue will become visible. By this method not only can contiguous changes producing filling defects be shown, but also minor alterations in the duodenal mucosa itself. By using the double-lumen gastroduodenal tube (Scott-Harden, 1960) and giving the oxyphenonium intravenously, we are able to perform this procedure, in the average case, in 15 minutes.