Introduction
Imaging techniques are crucial to arrive at a confirmatory diagnosis for any disease. Apart from conventional techniques, specialized imaging procedures have been designed aiming at organ specificity for more precision. For example, conventional X-rays have not proved beneficial in assessing the soft tissues of the digestive system, such as the stomach, large intestine, small intestine, and other organs. Hence, barium study (swallowing the contrast material prior to X-rays) was the most commonly used technique to assess and evaluate the digestive system; however, it had limited diagnostic value. Subsequently, endoscopy became the predominant diagnostic method as it could provide real-time images of the organs from the inside. However, endoscopy had certain drawbacks as it was invasive, offered limited accessibility, especially to the small bowel, and needed personnel with technical expertise. Hence there was a need for an alternative imaging tool primarily for the small intestine, which is difficult to be accessed.
What Is Enteroclysis?
Various imaging techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) have been used to image the small intestine. However, a novel technique exclusively applied in the small intestine was a procedure called enteroclysis. Enteroclysis is an imaging test that uses contrast material to view the small intestine. A contrast material is delivered to the small intestine through a flexible tube inserted into the nose. The images are then captured using an x-ray, CT, or MRI.
What Is CT Enteroclysis?
An enteroclysis procedure, when conducted using computed tomography, is known as CT enteroclysis. It is more convenient, efficient, and precise than conventional enteroclysis and is the preferred technique.
What Is the Difference Between Enteroclysis and Enterography?
Enteroclysis and enterography are procedures used to view the small intestine; however, the difference lies in how the contrast material is administered.
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Enteroclysis: The contrast is administered via a nasal tube.
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Enterography: The patients are made to drink the contrast material before the examination.
What Is the Difference Between MR Small Bowel and CT Enteroclysis?
Magnetic resonance imaging has a very crucial role in imaging the small bowel. The excellent soft tissue contrast, multiplanar imaging, nil ionizing radiation, and rapid imaging sequences have made MRI more desirable for diagnosing small bowel disorders. However, with the advent of technology and the introduction of multidetector CT (MDCT), CT enteroclysis has become more popular for imaging the small intestine. It is more efficient in identifying and characterizing small bowel pathologies. Early ulcerations, bowel distension, bowel wall thickening, and other pathologies can be well diagnosed through CT enteroclysis. In addition, the high specificity and sensitivity have proved CT enteroclysis to be more beneficial in diagnosing non-specific and asymptomatic small bowel abnormalities.
Where Is CT Enteroclysis Used?
CT enteroclysis is primarily indicated to detect any abnormalities in the small intestine. The conditions are mentioned below:
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Obstruction in the small intestine.
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Inflammatory bowel diseases (Crohn’s disease).
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Bleeding in the digestive tract.
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Malabsorption syndrome (the nutrients are not being absorbed normally).
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Any growth, tumor, or polyps.
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Post-operative scar tissue.
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Narrowing of the small bowel.
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Unexplained abdominal pain associated with chronic diarrhea.
What Are the Instructions to Be Followed by the Patient Before the Procedure?
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Bowel preparations are required before the procedure, as an empty bowel provides a clear view. Hence, patients are instructed to consume a liquid diet for at least 24 hours before the procedure.
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They should not eat or drink for six to eight hours before the procedure. Regular medicines can be taken with a few sips of water.
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Ladies who are or may be pregnant should inform the doctor before the procedure. Hence in pre-menopausal women, this procedure should be done within ten days of their menstrual cycle as the chances of pregnancy are nil.
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Patients with any history of allergy to medicines, latex, or contrast medium should notify the doctor.
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Laxatives will be given to the patient to clear their bowels. It has to be consumed the night before the procedure.
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Diabetic patients should consult their physician regarding their diet and the change in Insulin dosage or medications.
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Patients should wear loose, comfortable clothes and remove their jewelry or metallic accessories before the procedure.
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Patients will be asked to remove their hearing aids, eyeglasses, and other removable dental appliances, such as dentures or retainers.
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Medication causing constipation, such as iron tablets, must be stopped seven days before the procedure.
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Patients should inform the doctor of any recent history of illness or infections.
How Is CT Enteroclysis Done?
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The patient is advised to change into a hospital gown and is made to lie on the examination table.
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If the patient is anxious, conscious sedation can be used.
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A local anesthetic gel may be applied to the nose to numb the area.
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An enteroclysis tube (flexible tube) will be inserted through the nose or the mouth into the stomach and the small intestine. The patient may be asked to swallow repeatedly so the tube quickly passes into the intestine. This procedure is done under the guidance of fluoroscopy.
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Once the tube is positioned, the contrast material (sodium diatrizoate or barium solution) will be administered through the tube.
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The patient will then be taken to the CT room and made to lie with the CT machine, a tunnel-shaped device.
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An intravenous line will be accessed if a contrast CT is needed.
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The CT table moves forwards and backward, capturing the images. Patients may be asked to hold their breath while capturing the images.
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Once the scanning is complete, the tube will be removed from the nose, and the patient will be assisted to the recovery room.
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CT enteroclysis is usually done on an outpatient basis, and the entire procedure takes roughly one hour.
What Are the Instructions After the Procedure?
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The patient can continue their routine activities unless otherwise instructed by the physician.
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They can resume their regular diet.
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Patients are advised to consume plenty of water. This would help eliminate the contrast material quickly, and since barium is known to cause constipation, fluids can help facilitate bowel movement also.
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Patients are advised to eat fiber-rich foods so that the bowel is cleared. If required, a laxative may also be prescribed.
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Due to the barium, the stools will be lighter in color.
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Abdominal bloating and diarrhea are expected after the procedure, which may settle once the barium is passed in the stool.
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Lactating mothers can check with their doctors when they can resume breastfeeding.
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Diabetic patients taking Metformin may need to stop the drug for 48 hours after the procedure.
When to Seek Medical Advice?
Patients can contact their physician if they experience any of the following symptoms after the procedure:
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Inability to pass gas rectally.
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Constipated for more than two days.
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Fever.
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Abdominal pain or distension.
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Difficulty in bowel movement.
How Are the Results Interpreted?
The result is considered normal when there is no abnormality in the size or shape of the small intestine. An abnormal result would indicate a blockage, narrowing of the small intestine, a growth or a tumor, inflammation, or any abnormalities.
What Are the Benefits of the Procedure?
The benefits of the procedure are enlisted below:
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Painless and noninvasive.
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Gold standard diagnostic procedure to evaluate the small intestine.
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Well tolerated by the patients.
What Are the Risks Associated With the Procedure?
The risks associated with the procedure are mentioned below:
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Risk of radiation exposure. However, when compared with the benefits of the procedure, the risk can be neglected unless it is cumulative.
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Contraindicated in children and pregnant women.
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Possible allergic reaction to contrast medium.
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Injury to the adjacent structures during the examination.
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Barium is known to cause constipation.
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Rarely the contrast may cause renal dysfunction in patients with known kidney diseases.
Conclusion
CT enteroclysis is a valuable diagnostic tool to evaluate the small intestine and its abnormalities. Considering the accuracy, efficiency, and excellent patient compatibility, enteroclysis could easily be the mainstay diagnostic tool in imaging the small intestine.
