Use of water or air as oral contrast media for computed tomographic study of the gastric wall: Comparison of the two techniques

Abstract

Thirty-four patients with a high suspicion of gastric lesion at endoscopy were studied by two computed tomographic (CT) techniques: one using a gas-producing agent and the other using water as an oral contrast media. Intravenous contrast medium was also given in all patients who underwent the water technique. Final histologic proof was obtained either by endoscopy or at surgery. Both CT techniques detected the wall abnormality in 32 of the 34 patients, and both techniques missed the same lesion in two patients. The water technique showed more gastric wall details and the lesion's limits could be defined more accurately. The acceptance and tolerance of the gas-producing agent was better in severely ill patients than tap water.Upper gastrointestinal double-contrast barium studies [1, 2] and endoscopy [3] usually provide good diagnostic information about most gastric mucosa alterations.However, these methods cannot precisely determine the submucosal, intramural, or exophytic extension of a given gastric lesion.Computed tomography (CT) has been suggested as a complementary technique in the study of gastric wall lesions, since it allows direct visualizations of Address offprint requests to: Konstantinos J. Gossios, M.D., 9 Dosiou Str., Ioannina 453 33, Greece the gastric wall thickness and the neighboring tissues.Full gastric distention is necessary to appreciate the exact thickness of the gastric wall [4].It is believed that gastric wall thickening found on CT study is an important indicator of gastric tumor [5][6][7] or inflammatory process of the gastric wall [4].To achieve optimal distention of the gastric lumen, various techniques have been used. These include the ingestion of diluted iodinated contrast or barium solutions, the use of oil emulsion or gas distention by effervescent granules, and recently the use of water as oral contrast medium [8][9][10][11][12].Poor acceptance and tolerance for each of the above techniques will lead to underdistention of the gastric wall and to overestimation of gastric wall thickness.We prospectively studied the gastric wall by CT using gas or tap water in order to obtain optimal distention of the stomach and compared the advantages and disadvantages of these two techniques. Materials and MethodsThirty-four consecutive patients (23 male and 11 female) with a high suspicion of gastric lesion at endoscopy were included in this study. Their mean age was 63 years (range 34-83 years). All patients were examined prospectively by two CT techniques. One using a gas-producing agent as an oral constrast medium and the other using tap water in combination with additional intravenous contrast medium.Histologic proof was obtained by endoscopy or at surgery. The CT studies were performed using a fourth generation Somatom DR-2 scanner (Siemens) at 350 mA, 125 kV, with a 4-s

Determination of the Relationship Between Gastric Wall Thickness and Body Mass Index with Endoscopic Ultrasound

“…Despite a dramatic difference in BMI (31 points) between the two groups, the thickness of the gastric wall for nearly all patients was within the range of 3-4 mm. In the present study, the average overall thickness of the stomach was 3.29 mm which is similar to previously reported values [4,10,12,13]. Based on EUS measurements of the stomach, the gastric wall of morbidly obese patients is not significantly different from the gastric wall of patients with a normal BMI.…”

Evaluation of Bowel Distention and Bowel Wall Appearance by Using Neutral Oral Contrast Agent for Multi–Detector Row CT

“…Although investigators noted a more precise visualization of the intestinal wall, the predominant use of these negative oral contrast agents was restricted to tumor staging (16)(17)(18) and did not approach replacing positive contrast agents.…”

Comparison of neutral oral contrast versus positive oral contrast medium in abdominal multidetector CT

“…We, therefore, used a 3% mannitol solution in the expectation that mannitol's slight osmotic effect would produce better distention. This contrast agent is used at some institutions as part of a routine MR protocol for the examination of the small bowel, providing good small bowel distension without absorption [8,9,14,24].…”

“…It has excellent contrast behaviour in the upper GIT. Its clinical use for the distal parts of the small bowel, however, is limited due to its rapid absorption [10][11][12][13][14][15]. Additives can slow the absorption of water by increasing the osmolarity [16,17].…”