Head-to-Head Comparison of Oral Contrast Agents for Cross-sectional Enterography

Young, Brett M.; Fletcher, Joel G.; Booya, Fargol; Paulsen, S; Fidler, Jeff L.; Johnson, C. Daniel; Huprich, James E.; Barlow, John M.; Trout, Andrew T.

doi:10.1097/rct.0b013e318061961d

Cited by 88 publications

(32 citation statements)

References 18 publications

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“…Injection buscopan was given intramuscularly 45 min after initiation of drinking water to relieve patient discomfort and increase the patient compliance for drinking water. The distension of the small bowel loops in our study using PEGLEC was optimal and in concordance to the mentioned studies of Young BM et al, Kalra et al and Minordi et al (10,11,12) .…”

Section: Discussionsupporting

confidence: 92%

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CT Enterography for diagnosis of Small Bowel Disorders

Aggarwal¹,

Radiodiagnosis²

2018

jmscr

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Section: Discussionsupporting

confidence: 92%

“…Fletcher et al (10,13) . The reason may probably be lower acceptance of oral fluids by the time jejunum was to be distended.…”

Section: Discussionmentioning

confidence: 99%

CT Enterography for diagnosis of Small Bowel Disorders

Aggarwal¹,

Radiodiagnosis²

2018

jmscr

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“…Water is a biphasic contrast agent that has been used in the past; 4,6,14 however, it is rapidly absorbed and does not provide adequate distension of distal ileal loops. 6,15,16 Various compounds have been added to water to increase its retention in the lumen. These include highly osmolar agents such as polyethylene glycol, 14,16,17 mannitol 1,2,4,6 and sorbitol, 1,2,18 as well as non-osmotic agents that can form hydrogels, such as locust bean gum, 1,2,4,6 methylcellulose 16 and psyllium seed husk.…”

Section: Discussionmentioning

confidence: 99%

“…6,15,16 Various compounds have been added to water to increase its retention in the lumen. These include highly osmolar agents such as polyethylene glycol, 14,16,17 mannitol 1,2,4,6 and sorbitol, 1,2,18 as well as non-osmotic agents that can form hydrogels, such as locust bean gum, 1,2,4,6 methylcellulose 16 and psyllium seed husk. 4,6,19 There are currently two approaches to oral contrast administration: MR enteroclysis and MRE.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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Objective: To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE). Methods: This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n 5 20; psyllium, n 5 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg 21 psyllium prior to imaging.Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student's t-test and Mann-Whitney U-test.Results: Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p 5 0.338-0.908) and quantitative assessments (p 5 0.083-0.856). The mean bowel distension achieved was 20.1 6 2.2 mm for sorbitol and 19.8 6 2.5 mm for psyllium (p 5 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups. Conclusion: Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies. Advances in knowledge: This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.MR enterography (MRE) is an imaging technique used to evaluate the small bowel for diagnoses that include inflammatory bowel disease and neoplasms. Sufficiently distending the small bowel with an oral contrast agent (OCA) is critical, as collapsed loops may hide or mimic abnormalities.The OCAs employed in MRE can be classified as positive, negative or biphasic contrast agents according to their signal properties on T 1 and T 2 weighted imaging. Biphasic contrast agents typically provide low signal intensity on T 1 weighted imaging and high signal intensity on T 2 weighted imaging (T2W), and are most commonly used today because of their favourable signal characteristics for detecting bowel pathology. Water is a biphasic contrast agent, but its rapid physiological absorption from the small bowel necessitates the use of additives. These additives are often highly osmolar agents or non-osmotic agents that form hydrogels that trap water molecules in the bowel lumen. Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum. 1,2Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and eas...

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“…Its use in MR is considered an off-labeled use. This agent has been shown to provide better small bowel distention than water in the upper and lower abdomen [12]. Sorbitol, available commercially as a sweetening agent, is a sugar alcohol that promotes peristalsis and is a mild osmotic laxative [13].…”

Section: Methodsmentioning

confidence: 99%

A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: Implications for MR enterography

Bharucha

Fidler

Huprich

et al. 2014

European Journal of Radiology

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Objectives To assess if erythromycin increases gastric emptying and hence improves small intestinal distention during MR enterography. Methods Gastric, small intestinal, and large intestinal volumes were assessed with MR after neutral oral contrast (1350 mL in 45 minutes) and balanced randomization to erythromycin (200 mg i.v., age 31 ± 3y, 13 females), or placebo (37 ± 3y, 13 females) in 40 healthy asymptomatic volunteers. Fat-suppressed T2-weighted MR images of the abdomen were acquired on a 1.5T magnet at standard delay times for enterography. Gastric, small, and large intestinal volumes were measured by specialized software. In addition, two radiologists manually measured diameters and percentage distention of jejunal and ileal loops. Treatment effects were evaluated by an ITT analysis based on ANCOVA models. Results All subjects tolerated erythromycin. MRI scans of the stomach and intestine were obtained at 62 ± 2 (Mean ± SEM) and 74 ± 2 minutes respectively after starting oral contrast. Gastric volumes were lower (p < 0.0001) after erythromycin (260 ± 49 ml) than placebo (688 ± 63 ml) but jejunal, ileal, and colonic volumes were not significantly different. However, maximum (76–100%) jejunal distention was more frequently observed (p = 0.03) after erythromycin (8/20 subjects [40%]) than placebo (2/20 subjects [10%]). The diameter of a representative ileal loop was greater (p = 0.001) after erythromycin (18.8 ± 4.3 mm) than placebo (17.3 ± 2.8 mm) infusion. Conclusions After ingestion of oral contrast, erythromycin accelerated gastric emptying but effects on small intestinal dimensions were variable. In balance, erythromycin did not substantially enhance small intestinal distention during enterography using current standard delay times.

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Head-to-Head Comparison of Oral Contrast Agents for Cross-sectional Enterography

Abstract: Polyethylene glycol and LCB distend small bowel better than water and methylcellulose. Polyethylene glycol was the most difficult to drink and least preferred agent.

Cited by 88 publications

References 18 publications

CT Enterography for diagnosis of Small Bowel Disorders

CT Enterography for diagnosis of Small Bowel Disorders

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: Implications for MR enterography

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