RadteraSmall Bowel Follow-Through (SBFT)
Fluoro+ ContrastAbdomen & Pelvisverify
Indications
- Suspected Crohn disease / inflammatory bowel disease
- Small bowel obstruction (partial) or stricture
- Malabsorption evaluation
- Suspected small bowel mass or fistula
- Unexplained GI bleeding (after other workup)
Patient prep
- NPO at least 6-8 hours (NPO after midnight typical)
- Low-residue diet the day before per local protocol
- May follow a UGI series
Contrast
AgentThin (low-density) barium sulfate suspension; water-soluble iodinated agent if perforation suspected (note: dilution limits small bowel detail)
Routeoral
DoseLarge volume thin barium (often ~600 mL or more)
TimingSequential overhead radiographs at intervals (e.g., 15-30 min) until contrast reaches the cecum/terminal ileum, with fluoroscopic spot compression of the terminal ileum
Technique
- Patient drinks large volume of thin barium
- Obtain timed overhead abdominal radiographs (e.g., at 15, 30, 60 min and as needed) tracking transit
- Prone positioning helps separate loops
- Fluoroscopic compression spot images of regions of interest, especially the terminal ileum
- Continue until contrast reaches and opacifies the cecum/terminal ileum
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Timed overhead films | AP/PA prone | 15/30/60 min intervals tracking transit |
| 2 | Terminal ileum spot | Compression spot | Key for Crohn — wall thickening, strictures, fistula, skip lesions |
| 3 | Cecal filling confirmation | AP | Completion of study |
Key points
- Terminal ileum compression spot is the most important image (Crohn evaluation)
- Slower technique than enteroclysis but better tolerated (no nasoenteric tube); enteroclysis is more sensitive for subtle strictures/early Crohn
- CT/MR enterography has largely replaced SBFT for IBD in many centers but barium still excels for mucosal detail and motility
- Use water-soluble contrast cautiously — dilution and dispersion degrade small bowel mucosal detail
- Document transit time
References
• Recent advances in intestinal imaging — PMC3190487
• Radiopaedia: Small bowel follow-through
• ACR Appropriateness Criteria: Crohn Disease
• Radiopaedia: Small bowel follow-through
• ACR Appropriateness Criteria: Crohn Disease
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.