Small bowel enema
Enteroclysis is a fluoroscopic (real-time) type of X-ray of the small intestine. A barium-based liquid contrast material is infused through a tube from the nose or mouth, through the esophagus, and through the stomach until the tip reaches the duodenum (beginning of the small intestine).
X-rays are a form of electromagnetic radiation, as is light. They have higher energy than light, however, so they can penetrate the body to form an image on film. Structures that are dense appear white, areas that are less dense will appear black, and other structures will be shades of gray. The barium contrast used for this test is dense and can be seen clearly on X-ray.
The pictures in an enteroclysis study are displayed on a fluoroscopic monitor (similar to a television screen) in “real time” as the contrast moves through bowel structures. Periodic still pictures are taken as well.
How the test is performed
This test is done in a hospital radiology department. Periodic fluoroscopic examination may be necessary to guide the placement of the tube.
The liquid contrast (a mixture of barium and methylcellulose) is infused by a rate-controlled pump. The passage of the barium through the small intestine is monitored on the fluoroscope screen.
Pictures are taken in a variety of positions. The duration of the test is variable, but it may take several hours to complete.
How to prepare for the test
A clear liquid diet is suggested for at least 24 hours before the test. Laxatives may be prescribed to ensure that the bowel is clear of any particles that might interfere with the study.
MEDICATIONS, including narcotic pain relievers, that slow the normal movement of the digestive system, may need to be stopped on or before the day of the examination. Your health care provider will give you instructions regarding any changes to medications. Do not modify or stop taking any medications without consulting your health care provider.
If you are anxious about the procedure you may be given a sedative beforehand. You will be asked to remove all jewelry before the examination and you will wear a hospital gown. You must sign a consent form.
For infants and children:
The preparation you can provide for this test depends on your child’s age and experience. For specific information regarding how you can prepare your child, see the following topics:
- Infant test/procedure preparation (birth to 1 year)
- Toddler test/procedure preparation (1 to 3 years)
- Preschooler test/procedure preparation (3 to 6 years)
- Schoolage test/procedure preparation (6 to 12 years)
- Adolescent test/procedure preparation (12 to 18 years)
How the test will feel
The placement of the tube may be uncomfortable. Infusion of the contrast material may cause a feeling of abdominal fullness.
Why the test is performed
This test is performed to examine the small bowel and may identify lesions that had been seen on prior upper GI (gastrointestinal) X-ray series. It is the most complete means of demonstrating that the small intestine is normal if an abnormality is suspected.
The small intestine size and contours are unremarkable. Contrast travels through the bowel at a normal rate without any sign of obstruction.
What abnormal results mean
There are many abnormalities of the small intestine that may be identified with enteroclysis. Some of these include:
- Malabsorption states
- Partial, low grade, or intermittent small bowel obstruction
- Inflammation of the small bowel (such as Crohn’s disease)
- Intestinal stricture
- Small bowel disorders in patients with GI bleeding who have a normal upper GI series and lower GI series
- Primary or metastatic tumors of the small intestine
You should always discuss the significance of abnormal findings with your health care provider.
What the risks are
The type of radiation exposure is similar to other X-ray procedures. However, the radiation exposure may be greater with this test than with other types of X-rays because of the length of time needed for the fluoroscopic examination. Most experts feel that the risk is low compared with the benefits.
Pregnant women and children are more sensitive to the risks of X-ray radiation. If there is a chance that you are pregnant, you must inform your health care provider and an appropriate decision will be made regarding the necessity of the procedure.
Rare complications include allergic reactions to medications prescribed for the examination. You should consult with your health care provider to determine any known drug sensitivities. Another very rare complication is possible injury to bowel structures during the study.
Barium may cause constipation. Consult your health care provider if the barium has not passed through your system by 2 or 3 days after the test.
This test may not be able to evaluate some parts of the intestine because of the position of the tube or overlap by other areas that have already been filled with contrast. An alternative may be an abdominal CT scan.
by David A. Scott, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.