A comparison of paralysing agents in double-contrast barium meal examinations

One hundred and fourteen patients attending for barium meal examination were randomly allocated to receive Buscopan (hyoscine N-butylbromide, Boehringer Ingelheim; 20 mg) or glucagon (0.5 mg) as paralysing agents, or sterile water as control. The radiographs were analysed with regard to (a) gastric and duodenal distension and coating and (b) early or delayed filling of the duodenum with barium, in order to assess claims that paralysing agents influence radiographic quality. It was found that both duodenal distension and coating were better with Buscopan and glucagon than with water but there was no difference between Buscopan and glucagon in producing these effects. Relaxants produced no significant effect on distension or coating of the stomach. Glucagon prolonged the time of some examinations but gave better visualisation of the stomach, which was less frequently obscured by contrast in the duodenum.     

Assessment of the double contrast barium meal: method and application

A method of assessing and comparing double contrast barium meals has been devised. The use of the linear analogue scale has been found to be a consistent method of recording and measuring radiological impression of mucosal coating and gaseous distension. By this means the effectiveness of various currently available barium and gas preparations has been assessed in 125 patients. Appreciable differences in mucosal coating achieved by different barium preparations were detected. Satisfactory gaseous distension of the stomach and duodenum was produced in the majority of patients by all of the methods tested, and the following measurements are suggested as an index of good distension: gastric fundus 10 cm, gastric midbody 7 cm, duodenal loop 4 cm. The relationships between mucosal coating, gaseous distension and areae gastricae have been shown to be tenuous. It is suggested that the methods we have used are very suitable for repetition in other centres for the comparison of any of the many barium and gas-producing agents which continue to come on to the market.     

Double-blind radiographic study of dose response to intravenous glucagon for hypotonic duodenography.

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant (p less than 0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects.     

Dose reduction of hyoscine-N-butylbromide for double-contrast barium meal examinations--a prospective randomized study.

A search of the literature suggests that the conventional 20 mg dose of intravenous hyoscine-N-butylbromide (HBB) for smooth muscle relaxation in double-contrast barium meal (DCBM) studies is largely empirical. This study analysed the merits of three different doses (5 mg, 10 mg, 20 mg) in the performance of routine DCBMs. One hundred and twenty DCBM examinations were prospectively and randomly allocated to receive one of three doses. Three parameters were measured for each examination: gastroduodenal distension, delay in gastric emptying and gastric antrum overlapping with barium-filled duodenal loops. Almost half the examinations using 5 mg produced undesirable duodenal-gastric overlay. Unacceptable early flooding of the duodenal bulb with barium was seen mostly with doses of 5 mg and 10 mg. Overall, the best results were obtained with 20 mg. The continued use of 20 mg HBB in routine DCBMs is recommended.     

The natural history of the double pylorus

A study of 11 patients with "double pylorus" revealed that a second channel between the gastric antrum and the duodenal bulb is the result of ulcer penetration. The fistula can be a sign of spontaneous recovery from ulcerative disease; the fistula occurred in conjunction with clinical improvement in the majority of the patients. The advantages of radiological vs. endoscopic diagnostic procedures are discussed.     

Dose response to intramuscular glucagon during hypotonic radiography.

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13--18 min: the mean duration of moderate hypotonicity was approximately 4--7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4--7 min; the mean duration of moderate hypotonicity was 22--32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper Gl radiographic examinations. The onset of hypotonicity was 8--10 min with a duration of 12--27 min when this dose was given. Few reports of side effects were attributable to this dose.     

Compared effect of a genetically engineered glucagon and hyoscine N-butylbromide on double-contrast barium meal study

The aim of this study was to compare the effects of a genetically engineered glucagon (geG) and hyoscine N-butylbromide (HBB) on the quality of double-contrast barium meal (DCBM) study. Two hundred sixty-four patients scheduled for DCBM were randomized to receive intravenously geG 0.25 mg (geG-25), or geG 0.5 mg (geG-50), or HBB 20 mg as hypotonic agent. The evaluation concerned: duration of isolated visualization of the stomach (A); gastric mucosal coating (B); visualization of areae gastricae (C); quality of duodenal cap (D) and loop (E) study; delay, if any, of duodenal study (F). Global significant differences (P from 0.0183 to < 0.0001) were found for A, C, D, and F. GeG-50 allowed the longest isolated gastric visualization (P < 0.0001); geG-25 allowed more extensive visualization of areae gastricae than HBB (P = 0.0006); HBB allowed a better study of duodenal cap (P = 0.0052) and loop (P = 0.0190) than geG-25; geG-50 prolonged the examination time (P < 0.01). No adverse effect was observed with geG within 1 h after DCBM. In conclusion, geG can be safely used as a hypotonic agent in DCBM. When DCBM is focused on the stomach, 0.25 mg of geG is the optimal choice; if DCBM is focused on the duodenum, 0.5 mg of geG (with a prolonged examination time) or 20 mg of HBB (with a less effective study of the stomach) should be used. Received 14 July 1997; Revision received 9 September 1997; Accepted 12 September 1997     

Postpyloric Balloon Occlusion to Increase Technical Success during Pediatric Percutaneous Gastrostomy/Gastrojejunostomy Tube Placement

Gastric distension through insufflation is a key step in creating a safe percutaneous window during gastrostomy/gastrojejunostomy (G/GJ) placement; however, poor or incomplete gastric distention can occur, despite the use of glucagon, and lead to rapid egress of air from the stomach into the duodenum. This report describes the adjunctive technique using postpyloric balloon occlusion in 29 patients to maximize gastric insufflation during G/GJ tube placement after failure of conventional methods. Balloon occlusion was successful in salvaging 23 of 29 (79.3%) of G/GJ tube placements without any complications.     

胃壁内迷走胰腺的X线征象

目的提高对胃壁内迷走胰腺的认识。方法回顾性分析4例手术病理证实的胃壁内迷走胰腺的临床和钡餐检查X线表现。结果4例胃壁内迷走胰腺均发生在胃窦部近幽门区大弯侧,钡餐表现为轮廓较光滑的圆形或卵圆形充盈缺损,直径1～4cm,形态、位置固定,不随胃蠕动或触压而改变;临近黏膜可规整或粗乱,其中,典型的"脐样"征1例。结论主要X线征象为位于胃窦部幽门区大弯侧边缘光滑、位置固定、无溃疡的充盈缺损,难与息肉或平滑肌瘤或间质瘤等鉴别。     

Effect of glucagon-(1-21)-peptide on gastroduodenal motility during upper gastrointestinal examination. Randomized trials

The inhibitory effect of glucagon-(1-21)-peptide on the motility of the stomach and duodenum during radiologic double contrast studies was examined. In a randomized trial of equimolar doses of glucagon and glucagon-(1-21)-peptide on 70 patients, glucagon-(1-21)-peptide showed to have a significantly weaker effect than glucagon. Glucagon caused significant increases in plasma-glucose and plasma-insulin, while glucagon-(1-21)-peptide had no such effects. In a subsequent randomized study on 75 patients glucagon-(1-21)-peptide in various doses was tested against placebo. The effect was insignificant from that of placebo at practically all dose levels. No side effects were registered. It is concluded, that glucagon-(1-21)-peptide probably has a certain relaxing effect on the smooth muscle of the stomach and duodenum, but that this effect is too small for practical clinical use.     

直肠癌盆腔放疗后肠受照射影响因素的研究

目的 评价体位、性别、手术、膀胱充盈状态对直肠癌放疗后肠受照射的影响。方法36例直肠癌患者被研究，盆腔放疗采用1后2侧野三维适形放射治疗（3DCRT）的方法，处方剂量为50Gy。利用每个计划的剂量．体积直方图（DVH）对盆腔内肠的受照剂量和体积进行分析。结果膀胱充盈差和好时肠受照射的平均剂量分别是23．8和18．3Gy（P=0．004），V45高剂量受照体积分别是15．7％和7．8％（P=O．004）；体位仅对肠V15，低剂量受照体积有显著影响；性别对肠受照射的最大剂量和V15，有显著影响；手术对肠受照射的平均剂量有显著影响，分别是术前19．0Gy和术后22．5Gy（P=0．015）；在仰卧或俯卧、术前或术后膀胱充盈好时均比差时肠受照射剂量要低或体积要小。膀胱充盈好和差时肠受到高剂量照射的体积V4，在俯卧位分别是15．3％和7．4％（P=0．023），术后分别是14．1％和7．2％（P=0．014），差异有统计学意义。结论 患者治疗体位、性别、手术对盆腔内肠受照射剂量和体积有一定的影响，膀胱充盈状态有显著影响。     

Positioning During CT Gastrography in Patients with Gastric Cancer: the Effect on Gastric Distension and Lesion Conspicuity

Objective

We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG).

Materials and Methods

One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30° left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results.

Results

The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p < 0.001) in the gastric middle and lower portions. However, there was no significant difference between the LPO and supine positions (p ≥ 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach.

Conclusion

CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer.     

胃十二指肠良恶性狭窄的内支架治疗

目的探讨金属内支架在治疗不能手术的胃十二指肠交界处良恶性梗阻中的作用、疗效和并发症。方法１１例病人，８例术后吻合口复发狭窄，１例胃幽门良性狭窄，２例恶性狭窄。在透视监视下，使用介入放射学方法置入１１个自膨胀式金属内支架。结果１１例病人支架置入均成功，１０例梗阻症状立即解除，随访期间病人均能进食，疗效满意。本组无严重并发症发生。结论介入放射学置入金属内支架是一个简单、有效的治疗方法，对不能手术的胃出口部狭窄和术后吻合口狭窄有很好的缓解作用。     

Ferric ammonium citrate as a positive bowel contrast agent for MR imaging of the upper abdomen. Safety and diagnostic efficacy.

PURPOSE: To evaluate the safety and diagnostic efficacy of two different doses of ferric ammonium citrate as a paramagnetic oral contrast agent for MR imaging of the upper abdomen. MATERIAL AND METHODS: Ninety-nine adult patients referred for MR imaging for a known or suspected upper abdominal pathology were included in this randomized multicenter double-blind clinical trial. Imaging was performed with spin-echo (T1- and T2-weighted) and gradient-echo (T1-weighted) techniques before and after administration of either 1200 mg or 2400 mg of ferric ammonium citrate dissolved in 600 ml of water. Safety analysis included monitoring of vital signs, assessment of adverse events, and laboratory testing. Efficacy with regard to organ distension, contrast distribution, bowel enhancement and delineation of adjacent structures was graded qualitatively. RESULTS: No serious adverse events were reported for either of the two concentrations. A total of 31 minor side effects were noted, of which significantly more occurred in the higher dose group (p<0.01). The diagnostic confidence in defining or excluding disease was graded as better after contrast administration for 48% of all images. Marked or moderate enhancement of the upper gastrointestinal tract was achieved at both doses in 69.5% of cases with no evident difference between the two doses. The higher dose tended to show better results in terms of the contrast assessment parameters. CONCLUSION: Ferric ammonium citrate is a safe and effective oral contrast agent for MR imaging of the upper abdomen at two different dose levels. The higher dose showed a tendency toward better imaging results while the lower dose caused significantly fewer side effects. Therefore the 1200 mg dose can be recommended in view of the risk-to-benefit ratio.     

Radiologic Percutaneous Gastrostomy in Nondistended Stomach: A Modified Approach

Introduction

Gastrostomy tube placement for patients requiring long-term nutritional support may be performed using different techniques including endoscopic, surgical, and percutaneous radiologically guided methods. Radiologically inserted gastrostomy (RIG), typically performed when percutaneous endoscopic gastrostomy is not possible, requires proper gastric distension that is achieved by insufflating air through a nasogastric tube. We describe a simple technique to prevent air escape from the stomach during gastrostomy tube placement. To the best of our knowledge, this technique has not yet been described in the literature.

Materials and Methods

Four patients with unsuccessful percutaneous endoscopic gastrostomy were referred for fluoroscopic-guided gastrostomy. One patient had a pyriform sinus tumor and three had an ischemic stroke causing dysphagia. Gastric distention was not achieved in the patients due to air escaping into the bowel during the standard RIG procedure. A modified approach using a balloon catheter inflated in the pylorus to avoid air passing into the duodenum permitted successful RIG.

Results

The modified RIG procedure was successfully carried out in all cases without complications.

Discussion

Inadequate air distension of the stomach is an unusual event that causes a failure of gastrostomy tube placement and an increased risk of both major and minor complications. The use of a balloon catheter inflated in the first part of the duodenum prevents the air passage into the bowel allowing the correct positioning of the gastrostomy.

     

Colon distension, perceived burden and side-effects of CT-colonography for screening using hyoscine butylbromide or glucagon hydrochloride as bowel relaxant

Objective

Compare colonic distension and perceived burden of CT-colonography between participants receiving hyoscine butylbromide (buscopan) and glucagon hydrochloride as bowel relaxant.

Materials and methods

Data were collected within a screening trial. Participants received 20 mg buscopan intravenously or 1 mg of glucagon intravenously (if buscopan contra-indicated). Colon distension per segment was assessed using a 4-point scale (prone and supine). Data on perceived burden of CT-colonography were collected using a questionnaire two weeks after the examination. Outcome measures between groups were compared using propensity score matching. We used a stratified Wilcoxon–Mann–Whitney test statistic for quantitative and Cochran–Mantel–Haenszel statistics for categorical variables.

Results

541 participants were included: 336 (62%) received buscopan and 205 received glucagon. All buscopan recipients had an adequately distended colon, compared to 96% in the glucagon group (RR 7.31, 95% CI: 1.61–33.28). More glucagon recipients scored the insufflation as rather or extremely burdensome (25% vs. 16%; overall mean score 2.7 vs. 2.4; p < 0.001) and more found the entire CT-colonography rather or extremely burdensome (14% vs. 7%; 2.2 vs. 1.9; p = 0.001). Most frequently reported side effects were a dry mouth in the buscopan group (15%) and nausea in the glucagon group (13%).

Conclusion

Compared to glucagon, premedication with buscopan results in significantly more adequately distended colons and a less burdensome procedure. When buscopan can be used, it is the preferred bowel relaxant.     

口服速溶型助显剂在胃肠超声造影检查胃十二指肠疾病诊断中的应用

目的探讨口服速溶型助显剂在胃肠超声造影检查胃十二指肠疾病诊断中的应用。方法对85例患者进行胃肠超声造影检查与胃镜病理检查对照分析。结果胃肠超声造影检出各类胃炎60例,胃十二指肠溃疡10例,胃癌8例,胃间质瘤1例,胃息肉2例,胃下垂4例。超声造影检查与胃镜病理检查符合率约90％。结论口服速溶型胃肠超声造影检查对胃炎、胃十二指肠溃疡、胃癌有一定的诊断价值,可作为胃镜、X线钡餐造影的互补检查方法。     

The hypertrophied antral-pyloric fold

In 3.25% of 400 consecutive double-contrast upper gastrointestinal examinations, a prominent fold in the prepyloric gastric antrum that extends through the pylorus into the base of the duodenal bulb has been identified. Although the clinical significance of this fold is undetermined, endoscopic evaluation suggests it is a manifestation of chronic gastritis. This fold may simulate other entities, but can be distinguished by its characteristic features. Proper recognition may prevent unnecessary procedures such as endoscopy and biopsy.     

Dark-lumen MR colonography with fecal tagging: a comparison of water enema and air methods of colonic distension for detecting colonic neoplasms

The purpose was to evaluate MR colonography (MRC) with barium fecal tagging in detecting colorectal pathology and to determine how air-based and water-based colonic distension influences MRC. We studied 83 patients with high risk of colonic neoplasms. All received oral barium sulfate for colonic preparation before unenhanced and enhanced T1-weighted gradient-echo MRC using either water (n=54) or air (n=29) for colonic distension. Fecal tagging, distension, and artifacts were recorded. All patients underwent conventional colonoscopy within 2 weeks of MRC; the techniques were compared for detection of malignant neoplasms and polyps >or=1 cm, 6-9 mm, and or=1 cm, but more air-distended MRC were excluded for poor quality. MRC with fecal tagging is useful for detecting lesions >or=1 cm. Air distension was inferior to water distension in most aspects. Water-based colonic distension should be used for barium-tagging MRC.     

The laboratory response to glucagon dosages used in gastrointestinal examinations

Laboratory studies occasionally are necessary for patients who have undergone hypotonic gastrointestinal examinations. To ascertain the effects of glucagon on these patients, we determined the biochemical and hematologic responses to doses of 0.25-2 mg of glucagon in a double-blind crossover study. When glucagon was given intravenously or intramuscularly in increasing doses, serum values for glucose and insulin increased linearly up to 1 mg with a slight decrease at 2 mg. After intravenous and intramuscular administration of glucagon, the white blood cell count and the percentage of neutrophiles and bands increased, and the percentage of lymphocytes decreased. Reports of side effects included one each of nausea and mouth dryness after intravenous glucagon and four reports of nausea and one of mouth dryness after intramuscular glucagon. No changes in the pulse and blood pressure could be attributed to glucagon administration.