RadteraEnteroclysis (Small Bowel Enema)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Detailed small bowel evaluation when SBFT is inconclusive
- Suspected low-grade/partial small bowel obstruction or stricture
- Early Crohn disease / subtle mucosal lesions
- Suspected small bowel mass or unexplained GI bleeding
- Evaluation of small bowel adhesions
Patient prep
- NPO and bowel prep (low-residue diet, clear liquids, often cathartic) per protocol
- Patient counseling — nasoenteric/oroenteric tube placement is the least comfortable part
- Consider antiperistaltic agent (glucagon) availability
Contrast
AgentSingle-contrast: barium sulfate; Double-contrast: barium followed by methylcellulose (or air/CO2) as a negative agent; water-soluble if perforation suspected
Routevia nasoenteric/oroenteric (duodenal/jejunal) tube positioned beyond the ligament of Treitz
DoseControlled-rate infusion of barium (often via pump), then methylcellulose for double-contrast
TimingContinuous fluoroscopic monitoring of the advancing column
Technique
- Place enteric tube fluoroscopically with tip past the duodenojejunal junction (ligament of Treitz)
- Infuse barium at a controlled rate to produce continuous luminal distention
- For double-contrast, follow barium with 0.5% methylcellulose to distend and provide see-through effect
- Spot-image distended loops in multiple projections with compression
- Monitor the leading edge through to the terminal ileum/cecum
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Tube position check | AP | Tip beyond ligament of Treitz |
| 2 | Barium infusion (single-contrast) | AP + compression spots | Luminal contour, strictures |
| 3 | Methylcellulose phase (double-contrast) | AP spots | Mucosal detail, distention |
| 4 | Terminal ileum | Compression spot | Crohn changes |
Key points
- More sensitive than SBFT for subtle strictures, partial obstruction, and early Crohn, owing to controlled distention
- Double-contrast (barium + methylcellulose) best demonstrates strictures/stenoses but methylcellulose has a washout effect that can reduce fine superficial mucosal detail
- Less well tolerated than SBFT due to enteric intubation
- CT/MR enteroclysis combine intubation distention with cross-sectional detail and are replacing fluoroscopic enteroclysis in many centers
- Glucagon can reduce spasm/peristalsis to improve distention
References
• Multidetector CT enteroclysis vs barium enteroclysis with methylcellulose — European Radiology (PubMed 16552508)
• Recent advances in intestinal imaging — PMC3190487
• Radiopaedia: Enteroclysis
• Recent advances in intestinal imaging — PMC3190487
• Radiopaedia: Enteroclysis
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.