A prospective randomised study comparing enteroclysis with small bowel follow-through examinations in 244 patients

Abstract

The purpose of this study was to determine whether small bowel enema or barium follow-through is the most appropriate examination for the routine investigation of patients without documented small bowel disease referred from outpatient sources in our hospital. Two hundred and forty-four patients were prospectively randomised to either small bowel enema (SBE) or barium follow-through (FT). Radiation doses and room times were recorded for the first 95 patients and abnormal results were documented for all. One hundred and twelve FTs and 75 SBEs were performed. The incidence of abnormal results was low overall and comparable in the two groups. There were significantly more abnormalities in the FT group which required further investigations for confirmation. Of those assigned to SBE, 19% were converted to FT due to patient refusal and technical failure. Radiation doses were similar in the two groups, but the time spent occupying the fluoroscopy room was significantly shorter for FT. In our department FT is as effective as SBE in detecting small bowel abnormalities de novo. The radiation dose is similar, but more FTs can be performed per list. Follow-through is also less invasive than SBE and therefore we use this technique as the first line of investigation in this group of patients.

Forty-slice MDCT enteroclysis: evaluation after oral administration of isotonic solution in Crohn’s disease

“…Le principali limitazioni di questa tecnica sono riconoscibili nell'alta dose di esposizione per il paziente [2], anche a causa della necessità dell'utilizzo della guida fluoroscopica per il posizionamento del sondino naso-digiunale [3], nell'invasività conseguente all'intubazione naso-digiunale, e nell'incapacità di fornire informazioni dirette sull'eventuale interessamento extraparietale e/o eventuali complicanze. L'ecografia rappresenta una valida metodica per la diagnosi e il follow-up del MC [4,5], anche in relazione al possibile utilizzo dei mezzi di contrasto (MdD) ecografici [6], consentendo la valutazione diretta delle anse intestinali coinvolte dal processo flogistico, oltre che del suo grado di attività e dell'eventuale presenza di complicanze di malattia.…”

“…Its main limitations include the high radiation dose [2], in part related to the need to use fluoroscopy guidance for placement of the nasojejunal tube [3], the invasiveness of the intubation procedure and an inability to provide direct information on possible extraparietal involvement and/or possible complications. US is a valuable technique for the diagnosis and follow-up of CD [4,5], partly due to the possibility of using sonographic contrast media [6], as it allows direct evaluation of the diseased bowel loops and the degree of inflammatory activity and detection of complications.…”

What is the most accurate method for the assesment of small bowel in involvement in Crohn’s disease?

“…Although it is possible to detect the superficial changes of intestinal mucosa with barium enema, success of primarily fluoroscopic examination depends on the operator and the quality of the assessment. It is not possible to assess luminal thickness and changes in the vascularity; also it may not be possible to provide information about the extraintestinal involvement of CD via fluoroscopic studies (7,8).…”

Radiological Imaging of the Small Bowel

“…The technique is more suitable to detect a functional stenosis or to evaluate the passage time through the small bowel. This technique was mostly used in the USA and had quite similar results for detecting pathological changes of the small bowel, when performed by an experienced radiologist, compared to the enteroclysis of the small bowel using a double contrast, which represents the European approach [5,6,7]. For conventional small bowel enteroclysis, a nasojejunal probe has to be positioned fluoroscopically at the area at the ligament of Treitz to avoid contrast reflux [8].…”