Sodhi Jaswinder Singh, Zargar Showkat Ali, Rashid Wasim, Shaheen Feroz, Singh Manjeet, Javid Gul, Ali Sadaf, Khan Bashir Ahmad, Yattoo Ghulam Nabi, Shah Altaf, Gulzar Ghulam Mohamad, Khan Mushtaq Ahmed, Ahmad Zeeshan
Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190 011, India.
Indian J Gastroenterol. 2012 Apr;31(2):61-8. doi: 10.1007/s12664-012-0176-2. Epub 2012 May 15.
Small bowel follow through (SBFT) and enteroclysis have low sensitivity in picking up lesions in obscure gastrointestinal bleed (OGIB). Computed tomographic enterography (CT-EG), performed with 64-slice multiphase CT system by using large volumes of ingested neutral enteric contrast material, has high spatial and temporal resolution in visualization of the small bowel wall and lumen. The role of 64-slice multiphase CT-EG in the evaluation of OGIB is still evolving, and data on this role are scarce. We evaluated the efficacy of 64-slice multiphase CT-EG using polyethylene glycol (PEG) electrolyte solution as neutral contrast in patients of OGIB.
CT-EG was performed with 64-slice multiphase CT system using large volume (2,000 mL) of PEG electrolyte solution as oral contrast in patients of OGIB.
Thirty-five patients (21 men, age 41.4 [13.5] y, range 19-70 year) with OGIB underwent CT-EG; 20 patients had overt OGIB whereas 15 patients had occult OGIB. Among 15 patients with occult OGIB, 10 patients had iron deficiency anemia (IDA) with fecal occult blood test (FOBT) positive and 5 had IDA with FOBT negative. Thirty-two patients (92 %) completed the procedure successfully. The total time taken for the ingestion of 2,000 mL of PEG electrolyte solution was median 64 (range 60-78) minutes. Adequate luminal distension of small bowel was seen in 29 (90.6 %) patients for successful interpretation of radiological images. Fifteen of 32 (46.9 %) patients had positive findings on CT-EG; 12 of them underwent exploratory laparotomy. The surgical findings were in conformity with CT-EG findings in all patients, which included gastrointestinal stromal tumors (GIST; n = 6), carcinoid (1), Meckel's diverticulum (1), small bowel adenocarcinoma (2) and jejunal vascular malformation (2).
64-slice multiphase CT-EG is a useful investigation in the evaluation of both occult and overt OGIB.
小肠钡剂造影（SBFT）和小肠灌肠造影对不明原因胃肠道出血（OGIB）病变的检出敏感性较低。采用64层多期CT系统，通过口服大量中性肠道对比剂进行的CT小肠造影（CT-EG），在观察小肠壁和肠腔方面具有较高的空间和时间分辨率。64层多期CT-EG在OGIB评估中的作用仍在不断发展，关于这一作用的数据较少。我们评估了以聚乙二醇（PEG）电解质溶液作为中性对比剂的64层多期CT-EG在OGIB患者中的有效性。
对OGIB患者使用64层多期CT系统，口服大量（2000 mL）PEG电解质溶液进行CT-EG检查。
35例（21例男性，年龄41.4 [13.5]岁，范围19 - 70岁）OGIB患者接受了CT-EG检查；20例为显性OGIB，15例为隐匿性OGIB。在15例隐匿性OGIB患者中，10例粪便潜血试验（FOBT）阳性的患者患有缺铁性贫血（IDA），5例FOBT阴性的患者患有IDA。32例（92%）患者成功完成检查。口服2000 mL PEG电解质溶液的总时间中位数为64（范围60 - 78）分钟。29例（90.6%）患者小肠肠腔扩张良好，有利于影像学图像的成功解读。32例患者中有15例（46.9%）CT-EG检查结果为阳性；其中12例接受了剖腹探查术。所有患者的手术结果与CT-EG检查结果相符，包括胃肠道间质瘤（GIST；n = 6）、类癌（1例）、梅克尔憩室（1例）、小肠腺癌（2例）和空肠血管畸形（2例）。
64层多期CT-EG在隐匿性和显性OGIB的评估中是一种有用的检查方法。
