1 / 24

Imaging of the Small Bowel

Imaging of the Small Bowel. Carmen Meier, MD March 24, 2012. Small Bowel Facts. Consists of: duodenum, jejunum, ileum 20 to 30 feet long Role Digestion of proteins, carbohydrates, lipids Absorption of nutrients. Why image the small bowel?. Structural problems

anka
Download Presentation

Imaging of the Small Bowel

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Imaging of the Small Bowel Carmen Meier, MD March 24, 2012

  2. Small Bowel Facts • Consists of: duodenum, jejunum, ileum • 20 to 30 feet long • Role • Digestion of proteins, carbohydrates, lipids • Absorption of nutrients

  3. Why image the small bowel? • Structural problems • Strictures (medications, Crohn’s disease) • Inflammation (Crohn’s, infection, ischemia) • Masses or polyps • Foreign bodies (capsules) • Bleeding • Vascular ectasia (AVMs) • Masses/tumors • Polyps • Meckel's diverticulum • Dieulafoy's lesion • Ulcerations

  4. Radiology Imaging • Small Bowel Follow Through • Enteroclysis • CT • Tagged RBC scan • Angiography

  5. SBFT • Po radio-opaque contrast followed by serial x-rays • Position changes, abdominal pressure often needed • Unable to see small lesions or mucosal lesions (AVMs)

  6. SBFT • Useful for fistulas (Crohn’s disease)

  7. Enteroclysis • Injection of contrast followed by methylcellulose through nasoduodenal tube. Contrast coats the intestine and the methylcellulose distends the lumen to help with visualization.

  8. Enteroclysis • Con: nasoduodenal tube, uncomfortable, time-intensive

  9. CT Enterography • High volume (1200ml) negative oral contrast over 1 hour (no tube) • improves small bowel distension c/w regular CT • Give IV contrast to evaluate bowel wall

  10. Crohn’s Disease Crohn’s disease

  11. Tagged RBC scan • Small amount of blood drawn and labeled with radioactive material (Technetium) • Blood then re-injected and circulates: picked up by gamma scan

  12. Tagged RBC scan • Pro: may pick up slower bleed • Con: • Only approximate location given • Does not pick up intermittently bleeding lesions • No option for intervention

  13. Angiography • Selective cannulation and contrast injection of blood vessels by interventional radiologist under fluoroscopy to pick up brisk/active bleeding

  14. Angiography • Pro: Intervention possible (occlusion of bleeding vessel with coils, etc) • Con: • Fast, active bleeds only • Need at least approximate location • Invasive • High IV contrast load -> renal issues • Not available everywhere

  15. Endoscopic Imaging of Small Bowel • Video Caspule Endoscopy • Push Enteroscopy • Single Balloon Enteroscopy • Double Balloon Enteroscopy

  16. Capsule Endoscopy • Small capsule capable of taking sequential still images that are transmitted to receiver is swallowed by patient. • Capsule disposable. • Images downloaded from receiver and analyzed by MD.

  17. Capsule Endoscopy • Pro: Noninvasive • Con: • No control over images • Unable to intervene • Still requires prep • Takes some time • Not all patients suitable candidates

  18. “Standard” Enteroscopy • Pro: • Able to intervene • Biopsy, polypectomy, cautery, foreign body retrival • Con: • Invasive • Not suitable for all patients

  19. Push Enteroscopy • Simply pushing a (pediatric) colonoscope (180cm) or dedicated enteroscope (200cm) into the small bowel as far as possible • Limitations: • Uncomfortable (anesthesia) • Small bowel is non-fixed, and therefore difficult to simply advance scope • Looping in stomach

  20. Single Balloon Enteroscopy • Push-and-pull mechanism • Needed: Balloon Control Unit and single-use splinting tube • Most procedures take about 1 hour • Limitations: • Still uncomfortable for patient (anesthesia) • Post-surgical anatomy • Contraindicated with varices

  21. Single Balloon Enteroscopy

  22. Double Balloon Enteroscopy • One balloon on endoscope, one on overtube • Visualization of more distal small bowel • Limitations: • Fujinon system • More difficult to learn • 90-120 minutes procedure time

  23. Questions?

More Related