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

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.     

Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention

To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol–barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol–barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol–LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol–barium sulphate solution as an alternative for 1500-ml sorbitol–LBG solution for optimal bowel distension.     

Do magnesium ions influence barium mucosal coating of the large bowel?

The aim of the present study was to verify whether the presence of magnesium in the colon lumen at the time of the double-contrast barium enema (DCBE) examination changes the quality of barium mucosal coating. The two members of 38 pairs of patients undergoing DCBE with a standardised technique were randomly subjected to bowel preparation with sennosides and magnesium sulphate, or sennosides and sodium sulphate. Mucosal coating, residual fluid and colon cleansing were assessed independently by three radiologists. The null hypothesis was tested by means of Wilcoxon's signed-rank test. Barium mucosal coating was judged to be better in the members to whom magnesium sulphate was administered (p = 0.0007). There was no difference in the amount of residual fluids (p = 0.3198). Colon cleansing was judged to be better in the members to whom sodium sulphate was administered (p = 0.0166). These results demonstrate, in a simple way, that magnesium ions increase barium coating of the colon mucosa in vivo. The underlying mechanisms (increase in viscosity of barium suspension through water subtraction owing to the hydrophilism of magnesium ions, or interactions with the polysaccharide additives) need further investigation. A first clinical application could be the integration of magnesium ions in a newly designed isotonic electrolyte solution containing polyethylene glycol for the oral colon wash-out. Received: 7 July 1998; Revision received: 24 September 1998; Accepted: 29 September 1998     

Segmental dilatation of the small bowel: report of three cases and literature review

Segmental dilatation of the small bowel is a rare congenital abnormality that occurs mainly in children and produces significant nonspecific symptoms. The authors reviewed 33 cases reported in the literature and present three new cases in which the lesion was demonstrated on radiographs obtained before laparotomy. These cases showed the spectrum of symptoms and characteristic radiologic features of this condition in both plain abdominal radiographs and barium studies. Plain radiographs of the abdomen may show an isolated loop of bowel containing an air-fluid level. The characteristic finding in barium studies of the small bowel is a localized dilatation of the small bowel lumen with afferent and efferent loops. In the absence of a complication or coexistent cause of obstruction, the transit time of contrast medium through the small bowel is not delayed. The radiologic examination is useful in diagnosis, and the condition is cured with surgery.     

The use of non-ionic water-soluble contrast agents for small bowel follow-through examination

In certain situations it is preferable to perform small bowel examination using water-soluble contrast agents. Generally, ionic agents are used, but non-ionic agents may be an alternative in certain circumstances. We retrospectively reviewed a consecutive series of small bowel examinations using non-ionic media in order to determine their efficacy. A total of 52 water-soluble non-ionic small bowel follow-through examinations were performed in 42 patients using 100 ml iohexol. Indications for the study and the reasons why barium sulphate suspensions were contraindicated were established. Studies were assessed for radiographic quality and clinical findings were noted, and comparison was made with operative findings and clinical outcome. Obstruction was diagnosed in 12 examinations and the radiological findings were confirmed in all 7 patients surgically treated. Fistulae were identified in 11 examinations and the radiological findings were confirmed in all 8 patients who were treated by laparotomy. Additionally, at laparotomy no obstruction or fistula was found in the 5 patients in whom prior contrast examination had been negative. Non-ionic water-soluble follow-through examination is easily performed and well tolerated, allowing accurate diagnosis of obstruction and fistula when barium suspensions are contraindicated. Received: 17 February 1998; Revision received: 27 July 1998; Accepted: 29 July 1998     

A comparison of three methods for performing barium follow-through studies of the small intestine

Domperidone 8 mg intravenously and metoclopramide 10 mg intravenously, in patients given a standard barium sulphate preparation, were compared with a rapid-transit barium (E-Z-Paque, E-Z-Em) in a double-blind random controlled manner. E-Z-Paque and metoclopramide given with a standard barium preparation decreased small-bowel transit time and resulted in fewer radiographs being taken. Gastric emptying occurred most rapidly with metoclopramide and a standard barium sulphate preparation. There was no significant difference in the quality or diagnostic accuracy of the examinations with any of the three techniques, and no difference in the incidence of side-effects with the two drugs.     

Double-contrast study of the small intestine using enteroclysis. Considerations on the results in 250 patients

The value of double contrast small bowel enema via duodenal intubation using barium sulphate and methylcellulose as contrast media was assessed in 250 patients. In cases of small bowel obstruction it represented the first-line investigation after a plain abdominal film. It was performed electively in patients of painful bowel syndrome, in cases of malabsorption, in cases of endoscopically or radiologically diagnosed colitis and in patients with Crohn's disease. On the basis of our results we believe double contrast small bowel enema to be the most reliable investigation in the localization and identification of small bowel lesions.     

MSCT与气钡双重造影在小肠不明原因出血中的诊断价值

目的 评价多层螺旋CT扫描结合小肠气钡双重造影检查在小肠出血诊断中的价值.方法 对我院经胃镜及结肠镜检查未能明确的消化道出血患者行腹部CT并结合小肠气钡双重造影检查.结果 腹部多层螺旋CT检查及小肠气钡双重造影检查的诊断符合率分别为74.1％及55.2％.结论 采用腹部螺旋CT检查结合小肠气钡双重造影检查可以提高小肠出血的诊断符合率.     

Proximal small bowel transit pattern in patients with malabsorption induced by bovine milk protein ingestion.

Seven allergic patients with bovine milk or milk protein-inducible transient intestinal malabsorption exhibited radiologic signs of rapid transit of ingested barium through the proximal small intestine hours following oral challenge with bovine milk or milk protein solution. Control studies in the same patients without prior milk challenge revealed significantly more leisurely progress of contrast medium in the proximal small bowel. The possible pathogenetic role of such hasty transit through the functionally most effective portion of the digestive tract in patients with malabsorption points up the physiologic importance of roentgen examination of motility patterns in this particular segment of small bowel.     

Acute lethality after enteral administration of contrast media in anaesthetized rats with intestinal ischaemia

The acute lethality was evaluated during enteric follow-through in anaesthetized rats with a ligature applied to the anterior mesenteric artery and vein. In 121 animals 3 ml of either sodium diatrizoate, iohexol or barium sulphate was administered via orogastric tube. Alternatively, they had the oro-gastric tube inserted but no test substance instilled (controls). A total of 103 rats was observed until spontaneous death while 18 were sacrificed after 8 hours of observation. The survival time in the sodium diatrizoate group was significantly shorter than for the other three groups (p less than 0.006). The 50% survival time was 5 h 42 min (range 2 h 48 min to 12 h 45 min) for sodium diatrizoate as compared with 8 h 4 min to 8 h 26 min for the other three groups; iohexol 8 h 4 min (range 2 h 4 min to 14 h 43 min), barium 8 h 13 min (range 4 h 55 min to 16 h 26 min) and no instilled substance 8 h 26 min (range 3 h 38 min to 16 h 10 min) with no significant differences between these 3 groups. The use of hyperosmolar contrast media in enteric follow-through significantly shortens the survival of rats with acute intestinal ischaemia. A more rapid spread of intestinal bacteria through the distended bowel wall and the ensuing septicaemia, accompanied by enhanced dehydration, are probably the mechanisms responsible for the earlier deaths.     

Risks in roentgen study of the esophagus

X-ray examination of the oesophagus can lead to contact between the contrast medium and the lungs, connective tissue in the throat, and the mediastinum, pleura and peritoneum. The hyperosmolar iodine-containing contrast media used so far produce short-term displacement of liquid and local irritation. Long-term changes have not been reported. Contrast media containing barium sulphate will hardly produce irritation but may lead to chronic foreign body irritation; they should not be used if they are likely to come into contact with the pleura and peritoneum. Both water-soluble iodine-containing contrast media and barium sulphate-containing contrast media have resulted in deaths due to pulmonary inundation. In case of suspected disturbance of swallowing or perforation, a water-soluble contrast medium should be used at first. If there are no abnormal conditions, examination can be continued with barium sulphate contrast media. The new isoosmolar water-soluble contrast media offer interesting possibilities of detail improvement. Their better tolerance with satisfactory imaging properties should be established by animal experiments and by clinical tests.     

中药玄明粉在小肠双对比造影中的应用价值

目的 探讨中药玄明粉在小肠双对比造影中的应用价值.资料与方法 对随机抽查80例临床疑为小肠疾病患者,分两组:40例采用造影前2h口服玄明粉15 g(玄明粉组),40例常规口服法小肠双对比造影(对照组).对比剂均采用口服混悬钡,浓度为60%(W/V),总量350 ml,产气粉9g,进行对比.结果 口服玄明粉后可明显缩短造影时间;小肠清洁率优于对照组;病变显示率92.5%(37/40)显著高于对照组47.5%(19/40).结论 造影前口服中药玄明粉能使小肠清洁,缩短造影时间,明显提高了小肠疾病的检出率.     

Whipple's disease demonstrated by double contrast small bowel enema with barium and methylcellulose

The radiologic findings on small bowel enema examination using barium and methylcellulose (SBE + Ba + MC) in a patient with Whipple's disease before and after treatment are described. The changes on SBE + Ba + MC corresponded well to the clinical and morphologic picture. The advantages of this double contrast technique compared to the enteroclysis with barium alone are demonstrated. The SBE + Ba + MC is a good method to demonstrate the manifestations of Whipple's disease involving the small bowel and the mesentery.     

儿童克隆病的X线诊断

目的：探讨传统X线检查方法对儿童克隆病的诊断及其X线征象,以提高该病的X线检查诊断率,方法：28例行肠系钡餐和／或钡灌肠检查诊断为克隆病的患儿,经手术和病理学确诊13例,比较各种X线检查方法的诊断特异性及分析儿童克隆病的X线特征。结果：肠系钡餐对克隆病的诊断特异性为36．3％,钡灌肠为20．0％,两者联合应用诊断特异性显著提高达66．7％,儿童克隆病的X线特征易与肠结核,淋巴昆淆,结论：加强对和童克隆的重视,提高对X线征象的认识,以及联合应用肠系钡餐及钡灌肠检查方法将有助于克隆病诊断率的提高。     

Development of a new method for small bowel transit study

BACKGROUND AND PURPOSE: Currently, most studies combine the small bowel transit examination with gastric emptying time examination. There are significant drawbacks to this method. The radiotracer does not enter the small intestine in a bolus and the starting time for transit in the duodenum is difficult to define. This makes the result unreliable. In this study, we used a commercial enteric capsule containing radioactive charcoal to solve these problems. MATERIALS AND METHODS: Activated charcoal powder was mixed with Tc-99m pertechnetate and loaded to the enteric capsule which can resist gastric acid and dissolve only in the small intestine. In-vitro stability experiment was performed by immersing these capsules in a colorless phosphate buffer of variable pH which mimicked the condition in stomach and small intestine. In addition, ten healthy Chinese volunteers were included for in-vivo experiment. Anterior and posterior views of abdomen were obtained at regular 30-minute intervals until the eighth hour after administration of the radioactive enteric capsule. Small bowel transit time was calculated. RESULTS: The enteric capsule remained intact for at least 480 minutes in the solution mimicking gastric content (pH = 3.0) and disrupted at a mean duration of 227.2 minutes at a pH of 6.8 and at a mean duration of 212.4 minutes at a pH of 7.4 in the solution mimicking pancreaticobiliary secretions. In nine of ten volunteers, the small bowel transit time was between 30 to 270 minutes with a mean transit time of 140 min. In one volunteer, we failed to detect the exact time of small bowel transit because the capsule remained in the stomach throughout the study for up to 8 hours. CONCLUSIONS: We consider activated charcoal labeled with Tc-99m pertechnetate using an enteric capsule as the carrier to be a potential radioactive marker for small bowel transit study.     

Simplified assessment of segmental gastrointestinal transit time with orally small amount of barium

Objective

To determine the effectiveness and advantage of small amount of barium in the measurement of gastrointestinal transmission function in comparison with radio-opaque pallets.

Methods

Protocal 1: 8 healthy volunteers (male 6, female 2) with average age 40 ± 6.1 were subjected to the examination of radio-opaque pellets and small amount of barium with the interval of 1 week.Protocol 2: 30 healthy volunteers in group 1 (male 8, female 22) with average age 42.5 ± 8.1 and 50 patients with chronic functional constipation in group 2 (male 11, female 39) with average age 45.7 ± 7.8 were subjected to the small amount of barium examination. The small amount of barium was made by 30 g barium dissolved in 200 ml breakfast. After taking breakfast which contains barium, objectives were followed with abdominal X-ray at 4, 8, 12, 24, 48, 72, 96 h until the barium was evacuated totally.

Results

Small amount of barium presented actual chyme or stool transit. The transit time of radio-opaque pallets through the whole gastrointestinal tract was significantly shorter than that of barium (37 ± 8 h vs. 47 ± 10 h, P < 0.05) in healthy people. The transit times of barium in constipation patients were markedly prolonged in colon (61.1 ± 22 vs. 37.3 ± 11, P < 0.01) and rectum (10.8 ± 3.7 vs. 2.3 ± 0.8 h, P < 0.01) compared with unconstipated volunteers. Transit times in individual gastrointestinal segments were also recorded by using small amount of barium, which allowed identifying the subtypes of constipation.

Conclusion

The small amount barium examination is a convenient and low cost method to provide the most useful and reliable information on the transmission function of different gastrointestinal segments and able to classify the subtypes of slow transit constipation.     

Small bowel radiography: how, when, and why?

Since the advent of endoscopy for evaluating the upper and lower gastrointestinal (GI) tracts, it has become clear that only in the small bowel does barium radiography remain unchallenged. Regrettably, barium examination of the small bowel has traditionally been regarded by many radiologists as a study of minor importance. Small bowel follow-through techniques and enteroclysis methods differ in their diagnostic purpose, potential, and methods of performance. This review examines in detail the spectrum of barium examination techniques currently available for evaluating the small bowel. The benefits of enteroclysis in the majority of clinical situations requiring contrast examination of the small bowel are stressed. Radiologists play the crucial role in the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of small bowel radiography.     

Somatostatin. A new hypotonic agent in digestive tract radiography? Preliminary study

16 patients undergoing a conventional barium meal were treated with somatostatin, a hormone of the APUD (Amine Content Precursor Uptake and Decarboxylation) system, which is known to abolish gastric and pancreatic secretion and to exert an inhibitory effect on the motility, to evaluate its hypotonizing effect and usefulness in gastrointestinal radiology. A good hypotonic response elicited in the duodenum and, to a minor extent, in the small bowel, short lasting, consented an hypotonic duodenography during the standard examination with no interference on the barium intestinal transit in 14/16 patients. Inhibition of gastric and pancreatic secretions induced by the drug can promote a better mucosal coating in course of double contrast examinations.     

Scintigraphy of the small intestine: a simplified standard for study of transit with reference to normal values

Evaluation of small bowel transit, which should preferably be performed using non-invasive techniques, is complex owing to the anatomical position of the small bowel. In order to avoid any influence of the gastric emptying rate on scintigraphic results, we have used (99m)Tc-HIDA, an intravenous tracer that is excreted in bile and thereby delivered directly into the duodenum. Thirty healthy subjects were studied after an overnight fast. Immediately after administration of 120 MBq (99m)Tc-HIDA, dynamic 1-min image acquisitions were begun. The duodenum and caecum were easily identified on the digitised images. Small bowel transit time was determined from the difference in the arrival times of the radiopharmaceutical in the proximal duodenum and caecum, as assessed by evaluation of the count rate against background activity (Scint 1) and by the visual appearance of activity (Scint 2). Hydrogen breath test was performed simultaneously to evaluate scintigraphic transit. Scintigraphic transit tests were also performed in 23 patients with motility disorders who had undergone manometry of the small bowel. In healthy subjects, the transit time of (99m)Tc-HIDA was 77.9+/-31.1 min (Scint 1) or 79.3+/-30.9 min (Scint 2) and the lactulose transit time was 100.1+/-43.4 min. Seventeen of the 23 patients had a dysmotility pattern verified by manometry, and in 14 of these patients, (99m)Tc-HIDA transit was prolonged. (99m)Tc-HIDA small bowel transit is a readily available method for the detection of transit abnormalities in the clinical setting. The method is clinically feasible and the transit time of (99m)Tc-HIDA shows a good correlation with results of the hydrogen breath test (lactulose transit time) in healthy volunteers.     

Radiologic management of small bowel obstruction: A practical approach

The value of diagnostic imaging in the assessment of small bowel obstruction lies in its ability to answer questions to improve the clinical management of patients. These questions include: Is the small bowel obstructed? What are the level, cause, and severity of obstruction? Is strangulation likely to be present? Should treatment be operative or nonoperative? In this article, the different methods of contrast examination of the small bowel are reviewed, and recommendations to facilitate selection and performance of barium studies for small bowel obstruction are given. The indications for enteroclysis and computed tomography are discussed. A practical plain film-based approach to the diagnosis and management of small bowel obstruction is presented. Radiology assumes considerable importance and responsibility since it is able to supply relevant answers to many of the questions concerning small bowel obstruction.