Enteroclysis: Definition and Clinical Applications
Enteroclysis is a specialized radiological examination technique in which contrast material is directly infused into the small bowel via a nasoduodenal tube to achieve optimal distension, allowing for detailed visualization of the small intestine. 1
Technical Aspects of Enteroclysis
- Procedure: Involves placement of a nasoduodenal tube to allow controlled distention of the small bowel with contrast material 1
- Contrast Administration:
- Purpose: Achieves better small bowel distention compared to oral ingestion methods (enterography), particularly in the jejunum 1, 2
- Image Acquisition:
- For CT: Thin axial slices with multiplanar reconstructions
- For MR: Fast imaging techniques with specialized protocols
Clinical Applications
Crohn's Disease Evaluation
- Excellent diagnostic performance with >85% sensitivity and >90% specificity 1
- Superior detection of:
Small Bowel Tumors
- Imaging modality of choice for localization and characterization of small bowel tumors 2
- Allows for precise detection of intraluminal lesions that might be missed with conventional techniques 2, 3
Small Bowel Obstruction
- Facilitates analysis of low-grade small bowel obstruction better than conventional CT 2
- Particularly useful for detecting obstructive adhesive bands and strictures 3
Other Applications
- Detection of Meckel's diverticula and other diverticular disease 3
- Evaluation of blind pouch syndrome 3
- Assessment of fistulas and sinus tract lesions 1, 3
- Diagnosis of metastatic and primary carcinomas of the small bowel 3
Advantages and Limitations
Advantages
- Superior bowel distention compared to enterography techniques 1, 2
- Excellent examination performance for small bowel pathology 1
- Has been used as a reference standard for other imaging modalities in various studies 1
- Detects surgical lesions missed by conventional small bowel follow-through examinations 3
Limitations
- Invasive procedure requiring nasoduodenal tube placement 1
- Not suitable for acutely ill patients who cannot tolerate the procedure 1
- Discomfort and risks of duodenal intubation may outweigh benefits in some clinical scenarios 1
- Limited assessment of pure intestinal motility disorders and superficial mucosal lesions 2
- Less commonly performed in recent years as enterography techniques have become more widely utilized 1
CT vs. MR Enteroclysis
CT Enteroclysis
- Excellent for detecting complications of Crohn's disease (obstruction, abscess, fistula) 1
- Better for assessment of alternative diagnoses 1
- Particularly valuable for intermediate or advanced stages of Crohn's disease 2
MR Enteroclysis
- Avoids ionizing radiation 4
- Superior tissue characterization 4
- Multiplanar capabilities with excellent mural and extramural visualization 4
- Shows excellent agreement with conventional enteroclysis 4
- Can alter therapeutic strategy in patients with small bowel diseases 4
Clinical Considerations
- Patient selection is crucial - enteroclysis should be used selectively to answer specific questions about the small bowel 2
- Enterography techniques (oral contrast) are generally better tolerated by patients and have become more widely utilized 1, 5
- In acute settings, enteroclysis is typically not suitable as patients often cannot tolerate the procedure 1
- Technical expertise is required for proper execution, as poor technique can lead to examination failure 6
Enteroclysis remains an important diagnostic tool when detailed small bowel evaluation is required, though its invasive nature has led to increasing preference for enterography techniques in many clinical scenarios.