Improving visualization of distal and terminal ileum during the small bowel meal: an evaluation of fluoroscopic manoeuvres.

This study evaluated a variety of fluoroscopic manoeuvres used during small bowel meals for assessment of the terminal ileum and pelvic loops of small bowel. The purpose was to identify those manoeuvres which provide maximum diagnostic yield. Fifty-six consecutive patients undergoing small bowel meal and pneumocolon entered the study. The individual manoeuvres were graded and their contribution to diagnostic quality determined. An analysis of variance was used to determine the diagnostic value of the manoeuvres. There was a significant difference in the diagnostic quality provided by the different manoeuvres. Compression of the terminal ileum with the 'F spoon' and of the pelvic bowel loops with the compression paddle in the supine position provided the best diagnostic information in single contrast. The double contrast images obtained with the pneumocolon contributed most to the diagnostic quality of the examination. The results enable us to recommend a sequence of manoeuvres which are most likely to provide diagnostic views of the terminal ileum and pelvic ileal loops yielding maximum information and optimizing use of fluoroscopic time.