Technische Abbildungsqualität und endoluminaler Druck im Enteroklysma bei konstanter oder patientenindividuell adaptierter Kontrastmittelinstillation

Purpose: To compare the diagnostic quality, i.e. continuous distension and small bowel transparency, of two different enteroclysis protocols in a controlled randomised institutional review board approved trial evaluating the instillation rate, amount of contrast and distension media and endoluminal pressure. Methods and Materials: In 51 non-selected consecutive patients (protocol I: n=22, protocol II: n=29) a barium meal was introduced with a roller pump through an endonasal double-lumen probe placed at the duodenojejunal flexure. Switching to distension media was mandatory when contrast media reached the ileocaecal valve or was used up. Contrast media was restricted to a maximum of 650 mL in protocol I, but adjustment of contrast and distension media instillation rate due to bowel movement was allowed. In protocol II an unrestricted quantity of contrast media was administered with a constant rate of 70mL/min until the ileocaecal valve was reached. Adjustment of the instillation rate was allowed only for the distension medium. Endoluminal pressure was monitored constantly. Physicochemical properties of contrast and distension media were identical in both protocols. Two blinded expert reviewers rated the diagnostic quality from optimal (1), good (2), sufficient (3) to non-diagnostic (4). Results: In protocol I contrast media quantity and instillation time were significantly lower (473±93mL vs. 736±182mL and 9,8±4,7min vs. 17,2±8,8min; p<0,001) while instillation rate (71,1±23,4mL/min vs. 70,7±15,9mL/min), fluoroscopy time (23,1±9,6min vs. 21,6±10,2min) and maximum endoluminal pressure (57,6±15,8cmH20 vs. 62,9±17,8cmH2O, p=0,295) did not differ significantly. Distension medium quantity and instillation rate was almost identical in both populations (1586±400mL vs. 1503±431mL and 107,5±28,6mL/min vs. 115,3±27,0mL/min). Both reviewers rated diagnostic quality assured by protocol I higher on account of overall small bowel distension and transparency (protocol I: 1,9±0,8 vs. II: 2,5±0,9; p<0,053 and I: 2,0±0,7 vs. II: 2,7±0,8; p<0,010). Conclusion: Permanent adjustment of instillation rate during enteroclysis supports adequate contrast media quantity, small bowel distension and optimal transparency without increased fluoroscopy time thus improving diagnostic quality.