Comparison of two small bowel distending agents for enterography in pediatric small bowel imaging

Amy B. Kolbe, Leonard A. Haas, David J. Bartlett, Veena Iyer, Kristen B. Thomas, Jeanne Tung, Jeff L. Fidler, Joel Garland Fletcher

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the ability of pediatric patients with known or suspected inflammatory bowel disease to ingest a new oral distending agent at CT or MR enterography (CTE/MRE), and to determine the impact on small bowel (SB) distension and diagnostic confidence. Materials and methods: The study design is that of retrospective review of pediatric patients who underwent CTE or MRE from January 2014 to June 2016. Patients ingested low-concentration barium suspension or flavored beverage containing sorbitol and mannitol. The need for nasogastric tube (NGT) administration, amount ingested, emesis, distal extent of contrast, SB distension, terminal ileum (TI) transverse dimension, and diagnostic confidence in TI disease were assessed. Three radiologists each blindly reviewed a subset of the studies. Results: Of the total 591 scans in 504 patients, 316 scans used low-concentration barium suspension and 275 scans flavored beverage. Nearly all consumed the entire amount (97% vs. 96%). Low-concentration barium suspension exams required NGT more often (7% [23/316] vs. 1% [3/275]; p < 0.0003), and tended to have more emesis (3% [9/316] vs. 1% [3/275]; p = 0.13). Diagnostic confidence score was nearly identical (p = 0.94). Qualitative and quantitative analyses showed no difference in SB distension, except for distension of mid-ileum (flavored beverage > low-concentration barium suspension; p = 0.02). Flavored beverage exams demonstrated a slight increase in distal extent of luminal distension (p = 0.02). Conclusions: A new flavored beverage distends small bowel as well as low-concentration barium suspension, with decreased requirement for NGT insertion and improved distal extent of luminal distension, and without any decrease in diagnostic confidence in the presence or the absence of TI disease.

Original languageEnglish (US)
JournalAbdominal Radiology
DOIs
StatePublished - Jan 1 2019

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Barium
Beverages
Suspensions
Pediatrics
Ileum
Sorbitol
Mannitol
Inflammatory Bowel Diseases
Vomiting

Keywords

  • Crohn’s disease
  • Enteric contrast
  • Enterography
  • Oral contrast
  • Pediatric

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

Cite this

Comparison of two small bowel distending agents for enterography in pediatric small bowel imaging. / Kolbe, Amy B.; Haas, Leonard A.; Bartlett, David J.; Iyer, Veena; Thomas, Kristen B.; Tung, Jeanne; Fidler, Jeff L.; Fletcher, Joel Garland.

In: Abdominal Radiology, 01.01.2019.

Research output: Contribution to journalArticle

Kolbe, Amy B. ; Haas, Leonard A. ; Bartlett, David J. ; Iyer, Veena ; Thomas, Kristen B. ; Tung, Jeanne ; Fidler, Jeff L. ; Fletcher, Joel Garland. / Comparison of two small bowel distending agents for enterography in pediatric small bowel imaging. In: Abdominal Radiology. 2019.
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abstract = "Objective: To evaluate the ability of pediatric patients with known or suspected inflammatory bowel disease to ingest a new oral distending agent at CT or MR enterography (CTE/MRE), and to determine the impact on small bowel (SB) distension and diagnostic confidence. Materials and methods: The study design is that of retrospective review of pediatric patients who underwent CTE or MRE from January 2014 to June 2016. Patients ingested low-concentration barium suspension or flavored beverage containing sorbitol and mannitol. The need for nasogastric tube (NGT) administration, amount ingested, emesis, distal extent of contrast, SB distension, terminal ileum (TI) transverse dimension, and diagnostic confidence in TI disease were assessed. Three radiologists each blindly reviewed a subset of the studies. Results: Of the total 591 scans in 504 patients, 316 scans used low-concentration barium suspension and 275 scans flavored beverage. Nearly all consumed the entire amount (97{\%} vs. 96{\%}). Low-concentration barium suspension exams required NGT more often (7{\%} [23/316] vs. 1{\%} [3/275]; p < 0.0003), and tended to have more emesis (3{\%} [9/316] vs. 1{\%} [3/275]; p = 0.13). Diagnostic confidence score was nearly identical (p = 0.94). Qualitative and quantitative analyses showed no difference in SB distension, except for distension of mid-ileum (flavored beverage > low-concentration barium suspension; p = 0.02). Flavored beverage exams demonstrated a slight increase in distal extent of luminal distension (p = 0.02). Conclusions: A new flavored beverage distends small bowel as well as low-concentration barium suspension, with decreased requirement for NGT insertion and improved distal extent of luminal distension, and without any decrease in diagnostic confidence in the presence or the absence of TI disease.",
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AU - Haas, Leonard A.

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AU - Thomas, Kristen B.

AU - Tung, Jeanne

AU - Fidler, Jeff L.

AU - Fletcher, Joel Garland

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