Enteroclysis: Current clinical value

Abstract

AIM:To retrospectively analyze changes in clinical indication, referring medical specialty and detected pathology for small bowel double-contrast examinations. METHODS:Two hundred and forty-one (n = 143 females; n = 98 males; 01. 01.1990-31.12.1990) and 384 (n = 225 females; n = 159 males; 01.01.2004-31.12.2010) patients underwent enteroclysis, respectively. All examinations were performed in standardized double-contrast technique. After placement of a nasojejunal probe distal to the ligament of Treitz, radiopaque contrast media followed by X-ray negative distending contrast media were administered. Following this standardized projections in all four abdominal quadrants were acquired. Depending on the detected pathology further documentation was carried out by focused imaging. Examination protocols were reviewed and compared concerning requesting unit, indication and final report. RESULTS:Two hundred and forty-one examinations in 1990 faced an average of 55 examinations per year from 2004-2010. There was an increase of examinations for gastroenterological (33.6% to 64.6%) and pediatric (0.4% to 7.8%) indications while internal (29.0% to 6.0% for inpatients and from 16.6% to 9.1% for outpatients) and surgical (12.4% to 7.3%) referrals significantly decreased. "Follow-up of Crohn's disease" (33.1%) and "bleeding/tumor search" (15.1%) represented the most frequent clinical indications. A total of 34% (1990) and 53.4% (2004-2010) examinations yielded pathologic findings. In the period 01.01.2004 -31.12.2010 the largest proportion of pathological findings was found in patients with diagnosed Crohn's disease (73.5%), followed by patients with abdominal pain (67.6% with history of surgery and 52.6% without history of surgery), chronic diarrhea (41.7%), suspected Crohn's disease (39.5%) and search for gastrointestinal bleeding source/tumor (19.1%). The most common pathologies diagnosed by enteroclysis were "changes in Crohn's disease" (25.0%) and "adhesions /strictures" (12.2%).CONCLUSION: "Crohn's disease" represents the main indication for enteroclysis. The relative increase of pathologic findings reflects today's well directed use of enteroclysis.

The small bowel diseases detected by capsule endoscopy in patients with chronic abdominal pain

“…Computed tomography enteroclysis (CTE) and magnetic resonance imaging enterography (MRIE) have been recommended as first-line modalities. [ 38 ] Compared with CTE and MRIE, CE might have high sensitivity to the mucosal lesions, such as erosions and superficial ulcers which are difficult to be shown on radiographic imaging. On the other hand, push enteroscopy and balloon-assisted endoscopy have been used for examining the small bowel in the present decade.…”

A review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures

“…Three studies have examined the efficacy of inhaled methoxyflurane for types of outpatient procedures associated with significant patient discomfort that otherwise might require sedation. 25,32,53,54 Patients undergoing computed tomography enteroclysis for the diagnosis and assessment of small bowel disease require nasal insertion of the endoscope and injection of contrast material into the bowel, which may cause significant discomfort, sometimes requiring i.v. sedation for patient comfort, with the attendant risks of drowsiness and respiratory depression.…”

“…sedation for patient comfort, with the attendant risks of drowsiness and respiratory depression. 54 One study has examined the use of methoxyflurane as an alternative analgesic modality. 53 In this randomised double-blinded comparison against placebo, methoxyflurane significantly reduced patient discomfort during nasal insertion of the endoscope, but did not reduce the discomfort of other parts of the procedure in comparison with placebo.…”

The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn’s disease

“…CE is a technique based on distending the small bowel with barium-methylcellulose suspension, which enables to detect mucosal changes and luminal abnormalities (5,6). CE also gives func-Clinical or laboratory parameters Impact factor Liquid or soft stools every day for seven days x2 Need for Lomotil or opiates for diarrhea x30 Poor general health conditions every day for seven days (subjectively scored from 0 (good) to 4 (very bad)) tional information on the dynamic nature of the intestines, which allows the evaluation of bowel distensibility and fi xation of bowel loops (6).…”

“…CE also gives func-Clinical or laboratory parameters Impact factor Liquid or soft stools every day for seven days x2 Need for Lomotil or opiates for diarrhea x30 Poor general health conditions every day for seven days (subjectively scored from 0 (good) to 4 (very bad)) tional information on the dynamic nature of the intestines, which allows the evaluation of bowel distensibility and fi xation of bowel loops (6). However, CE gives only indirect information on the bowel wall and perienteric changes, and can be technically challenging due to the overlapping of bowel loops (5,6). The age is an important feature to be considered in the management of younger patients due to accumulation of the radiation dose over time by repetitive imaging studies (7,8).…”