Published online Jul 28, 2013. doi: 10.4329/wjr.v5.i7.253
Revised: May 26, 2013
Accepted: June 8, 2013
Published online: July 28, 2013
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.
Core tip: The double contrast examination of the small intestine by enteroclysis is a well-established diagnostic tool for small bowel diagnostics. Comparing the number of performed investigations, it becomes obvious that modern endoscopic and radiological methods lead to an increased replacement of classical radiological methods such as enteroclysis. On the other hand the increasing proportion of pathological findings, as shown in the presented study, justifies the continued use of enteroclysis for dedicated clinical indications in a structured diagnostic chain.