The ability to directly visualize bowel pathology is limited, and evidence for CD is instead inferred indirectly. There is little role for radiography in this clinical variant. Fluoroscopy Small-Bowel Follow-Through Historically, fluoroscopic contrast examinations of the gastrointestinal tract have been the primary imaging methods of choice in the evaluation of CD. SBFT (with or without per oral pneumocolon) and enteroclysis can be used to evaluate the small bowel for evidence of thickening and active disease [50,79]. In addition, internal fistulas can be detected [80], although other extramural complications such as abscess formation are only indirectly visualized, which lead to decreased detection [27]. It has become evident; however, with the emergence of specialized cross sectional imaging modalities, that the performance of contrast fluoroscopy is not as accurate for active disease as compared with these other examinations [18,42,46,81,82]. Thus, there is little evidence to support its use in this specific clinical variant in which the inflammation may be very subtle. Both SBFT and enteroclysis are hampered by their 2-D perspective, whereby pathology can be obscured because of overlapping bowel loops [18,82,83]. On the other hand, the real-time assessment for a fixed versus pliable nature of a segment of bowel can provide important ancillary information. Dependent on institutional and surgeon preference, there may be a role in delineating the preoperative anatomy for the surgeon, although there has been a marked decline in fluoroscopic use over recent years. Fluoroscopy Contrast Enema Colonoscopy is the preferred initial examination of the colon in patients suspected of having inflammatory bowel disease [9]. It is superior to the barium enema for the detection of early inflammatory changes and has largely replaced it as the diagnostic examination [9].
Crohn Disease. The ability to directly visualize bowel pathology is limited, and evidence for CD is instead inferred indirectly. There is little role for radiography in this clinical variant. Fluoroscopy Small-Bowel Follow-Through Historically, fluoroscopic contrast examinations of the gastrointestinal tract have been the primary imaging methods of choice in the evaluation of CD. SBFT (with or without per oral pneumocolon) and enteroclysis can be used to evaluate the small bowel for evidence of thickening and active disease [50,79]. In addition, internal fistulas can be detected [80], although other extramural complications such as abscess formation are only indirectly visualized, which lead to decreased detection [27]. It has become evident; however, with the emergence of specialized cross sectional imaging modalities, that the performance of contrast fluoroscopy is not as accurate for active disease as compared with these other examinations [18,42,46,81,82]. Thus, there is little evidence to support its use in this specific clinical variant in which the inflammation may be very subtle. Both SBFT and enteroclysis are hampered by their 2-D perspective, whereby pathology can be obscured because of overlapping bowel loops [18,82,83]. On the other hand, the real-time assessment for a fixed versus pliable nature of a segment of bowel can provide important ancillary information. Dependent on institutional and surgeon preference, there may be a role in delineating the preoperative anatomy for the surgeon, although there has been a marked decline in fluoroscopic use over recent years. Fluoroscopy Contrast Enema Colonoscopy is the preferred initial examination of the colon in patients suspected of having inflammatory bowel disease [9]. It is superior to the barium enema for the detection of early inflammatory changes and has largely replaced it as the diagnostic examination [9].