Does a normal small-bowel enteroclysis exclude small-bowel disease? a long-term follow-up of consecutive normal studies

Abstract

The purpose of our study was to determine if a normal small-bowel enteroclysis excludes small-bowel disease in adult patients, using long-term follow-up as the major reference standard. We reviewed 193 consecutive small-bowel enteroclysis (SBE) studies completed during a period from January 1987 to February 1989, of which 83 were judged to be normal at the time of the study. Eight of these latter patients were excluded due to inadequate follow-up. The indications included detection of gastrointestinal bleeding, small-bowel obstruction, Crohn's disease, nonspecific abdominal pain, chronic diarrhea, and a miscellaneous group. Each patient was followed for at least 3 years by chart review or until a definite diagnosis was established. Six of the 75 patients whose SBE was originally interpreted as normal were eventually judged to have small-bowel disease. The remaining 69 patients were judged to be free of small-bowel disease by autopsy, surgical laparotomy, endoscopic observation or biopsy, or long-term follow-up for at least 3 years. Therefore, a normal SBE correctly excluded small-bowel disease in 69 of our 75 patients (true negatives) and failed to diagnose disease in six patients (false negatives), for a specificity of .92 +/- .03 (SE). In this experience, SBE was sufficiently specific in most patients to exclude small-bowel disease.

Magnetic resonance imaging evaluation of small intestinal Crohn's disease

“…For T 1 -weighted images, most authors use gradient echo sequences in two-and three-dimensional acquisition modes with or without fat saturation prepulses (Figure 1), whereas for T 2 -weighted images, TSE and HASTE sequences are commonly employed. 2,19,20 More recently, the true FISP sequence has been successfully applied in bowel imaging, 12 providing high-resolution images of the bowel wall ( Figure 2) and additional information from the mesentery. Fat-suppressed TSE or STIR sequences have been also applied to assess activity in Crohn's disease.…”

“…1,2 The main limitation of enteroclysis remains its inability to demonstrate associated exoenteric pathology. In parallel, an increasing role has been established for computed tomography in evaluating mural and extramural lesions.…”

European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis

“…Therefore, SBE has been considered the optimum investigation for CD, with a sensitivity of 93% and a specificity of 92% to exclude small bowel disease. [51][52][53] In routine practice SBFT is simpler and may be preferred; it was superior to SBE for detecting mucosal disease, fistulas, or gastroduodenal involvement in a comparative study in CD, 54 55 but is operator dependent and not as good for strictures. The debate is unlikely to be resolved by wireless capsule enteroscopy or other techniques in the near future.…”

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

“…Several large series demonstrate the efficacy of SBE [1,2,3,4,5,6]. Retrospective studies attest to the superior sensitivity and specificity of SBE compared with FT [7,8].…”