Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

<p>Abstract</p> <p>Background</p> <p>Video capsule enteroscopy (VCE) has revolutionized small bowel imaging, enabling visual examination of the mucosa of the entire small bowel, while MR enteroclysis (MRE) and CT enteroclysis (CTE) have largely replaced conventional barium enteroclysis. A new indication for MRE and CTE is the clinical suspicion of small bowel strictures, as indicated by delayed or non-delivery of a test capsule given before a VCE examination, to exclude stenosis. The aim of this study was to determine the clinical value of subsequent MRE and CTE in patients in whom a test capsule did not present itself in due time.</p> <p>Methods</p> <p>Seventy-five consecutive patients were identified with a delayed or unnoticed delivery of the test capsule. Seventy patients consented to participate and underwent MRE (44) or CTE (26). The medical records and imaging studies were retrospectively reviewed and symptoms, laboratory results and imaging findings recorded.</p> <p>Results</p> <p>Lesions compatible with Crohns disease were shown by MRE in 5 patients, by CTE in one and by VCE in four, one of whom had lesions on MRE. In patients without alarm symptoms and findings (weight loss, haematochezia, anaemia, nocturnal diarrheoa, ileus, fistula, abscess and abnormal blood tests) imaging studies did not unveil any such lesion. VCE's were performed in only 20 patients, mainly younger than 50 years of age, although no stenotic lesion was shown by MRE and CTE. In the remaining 50 patients no VCE or other endoscopic intervention was performed indicating that the referring physician was content with the diagnostic information from MRE or CTE.</p> <p>Conclusion</p> <p>The diagnostic value of MRE and CTE is sufficient for clinical management of most patients with suspected small bowel disease, and thus VCE may be omitted or at least postponed for later usage.</p

Análise retrospectiva do trânsito do delgado em um serviço de radiologia de hospital geral Retrospective analysis of small bowel contrast examinations at the radiology service of a general hospital

OBJETIVO: Os autores se propõem a revisar os exames de trânsito do delgado, a fim de demonstrar os principais diagnósticos e achados radiológicos, e o atual benefício para o paciente. MATERIAIS E MÉTODOS: Estudo retrospectivo e descritivo realizado a partir de levantamento de exames realizados no período de janeiro/2001 a junho/2002, no serviço de radiologia do Hospital Santa Cruz da Beneficência Portuguesa de Niterói. RESULTADOS: Do total de 60 exames, 24 (40,0%) apresentaram alterações radiológicas (anatômicas, enterites, divertículos, relacionadas a cirurgias e outras) e 36 (60,0%) foram normais. Observamos que 36 pacientes (60,0%) tinham entre 35 e 65 anos incompletos, apenas dois (3,32%) eram menores de 18 anos e o paciente mais idoso tinha 87 anos. CONCLUSÃO: Apesar do advento da endoscopia para a avaliação do trato gastrintestinal superior e inferior, o uso do estudo contrastado do intestino delgado se manteve como método de escolha para avaliação do duodeno, jejuno e íleo. Sabe-se que o trânsito do delgado é a principal técnica diagnóstica para o estudo deste órgão e importante para o estudo das enterites, além de ser um exame de fácil execução e de alta sensibilidade. Dessa forma, estamos reforçando a sua importância diagnóstica e devemos ter em mente que o exame do trato gastrintestinal superior é complementar, devendo considerar suas limitações e vantagens.<br>OBJECTIVE: To review small bowel contrast examinations in order to identify the main findings and to determine the actual benefits to the patient. MATERIALS AND METHODS: This was a retrospective and descriptive study based on data of 60 examinations performed between January, 2001 and June, 2002 at the radiology department of the "Hospital Santa Cruz/Beneficência Portuguesa de Niterói", Rio de Janeiro, Brazil. RESULTS: A total of 60 examinations were reviewed: 24 (40.0%) showed abnormal radiological findings whereas 36 (60.0%) were normal. Thirty-six patients (60%) were between 35 and 65 years of age, only two (3.32%) were below 18 years and the oldest patient was 87 years. CONCLUSION: In spite of the new diagnostic imaging modalities such as endoscopy, small bowel contrast examinations are unlikely to fall into disuse and may remain the modality of choice for the investigation of this segment of the intestines. Therefore, we should keep in mind that small bowel contrast examinations and endoscopy are complementary rather than alternative methods when the advantages and disadvantages of each method are considered. Contrast examination of the small bowel is still an important and valuable method for the investigation of this segment of the intestines