Fluoroscopy Small-Bowel Follow-Through and Fluoroscopic Enteroclysis Historically, fluoroscopic contrast examinations of the gastrointestinal tract have been the primary imaging methods of choice in the diagnosis of CD. Small-bowel follow-through (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 leads 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 to these other examinations [18,42,46,81,82]. 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. Depending 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. In addition, fluoroscopic examinations may not be tolerated in acutely ill patients because of the oral contrast requirements for these procedures. Fluoroscopy Contrast Enema Colonoscopy is the preferred initial examination of the colon in patients suspected of having inflammatory bowel disease primarily involving the colon as opposed to the small bowel [9]. Colonoscopy is superior to the barium enema for the detection of early inflammatory changes and has largely replaced it as the initial diagnostic examination [9]. Particularly in an acutely ill patient, a contrast enema may be technically challenging because of the need for retrograde contrast instillation. Crohn Disease
Crohn Disease. Fluoroscopy Small-Bowel Follow-Through and Fluoroscopic Enteroclysis Historically, fluoroscopic contrast examinations of the gastrointestinal tract have been the primary imaging methods of choice in the diagnosis of CD. Small-bowel follow-through (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 leads 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 to these other examinations [18,42,46,81,82]. 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. Depending 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. In addition, fluoroscopic examinations may not be tolerated in acutely ill patients because of the oral contrast requirements for these procedures. Fluoroscopy Contrast Enema Colonoscopy is the preferred initial examination of the colon in patients suspected of having inflammatory bowel disease primarily involving the colon as opposed to the small bowel [9]. Colonoscopy is superior to the barium enema for the detection of early inflammatory changes and has largely replaced it as the initial diagnostic examination [9]. Particularly in an acutely ill patient, a contrast enema may be technically challenging because of the need for retrograde contrast instillation. Crohn Disease