Sonoenteroclysis: a new technique for the diagnosis of small bowel diseases

Abstract

Background: Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis.

Methods: Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis.

Results: Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 +/- 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1).

Conclusions: The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.