Lesions missed on small-bowel follow-through: analysis and recommendations.

Abstract

Forty-two surgically confirmed small-bowel lesions that were not detected by small-bowel follow-through but were demonstrated by enteroclysis were analyzed to determine why small-bowel follow-through had failed to detect them. Thirty lesions (71%) were not seen in retrospect; this was attributed to technical inadequacies. Twelve lesions (29%) were seen in retrospect. Of these, two (17%) of the lesions had been missed originally because of perceptive errors, seven (58%) because of combined perceptive and technical errors, and three (25%) because of interpretive errors. The preponderance of technical errors emphasizes the need for improvements in the small-bowel follow-through technique. More frequent fluoroscopy and more thorough compression of all filled segments, as is performed in enteroclysis, and a decreased reliance on overhead radiographs should decrease the error rate in the routine small-bowel follow-through examination.

Impact of the small bowel study on patient management

“…The peak prevalence of obstruction, adhesions, and miscellaneous lesions was in patients between 51 and 70 years, whereas the highest prevalence of Crohn's disease was in patients under 30 years. Positive results also depended on the technique used [5,7]. The positive rate of peroral small bowel examination was 29% (119 of 417 patients) compared to 48% (53 of 111 patients) for enteroclysis (p < 0.01).…”

Utilidad de la cápsula endoscópica como método diagnóstico en el estudio de patología de intestino delgado

“…La CE es una modalidad nueva de explorar el intestino delgado, su principal ventaja es la capacidad de visualizar la mucosa con mínimos riesgos para el paciente, y en comparación con el estudio radiológico de intestino delgado, tiene una mayor capacidad de detectar lesiones planas como las angiodisplasias 30 . Las complicaciones descritas para el procedimiento son bajas 31 , la más importante aunque infrecuente es la retención [32][33][34][35] .…”

Adult Crohn disease: can ileoscopy replace small bowel radiology?

“…This is the technique used at our institution. An optimal examination entails administration of a gastric-emptying agent [22], an adequate contrast volume with top up if transit is slow, and careful fluoroscopy and compression of loops [23]. The examination may also be modified by a peroral pneumocolon [24,25] and administration of effervescent tablets [26].…”