SBFT vs. enteroclysis

[nuclearrabbit77]

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can ya'll give me a brief breakdown on each w/advantages disadvantages?

thanks

 

[RADRULES]

Enteroclysis is much better, however can be uncomfortable for the patients. SBFT I find pretty worthless.

 

[Docxter]

As someone who has been trained with the best in both, I would say I absolutely disagree with Radrules that SBFT is worthless. We do about three SBFTs a day and diagnose Crohn's disease by SBFT about once every other day. About once or twice a week we diagnose some other entity by SBFT which was undiagnosed by CT or other measures. SBFT is also pretty good for determining Crohn's activity in known patients or specifying the exact location and characteristics of enteric fistulas. Low-grade internal hernias are also easily dianosed by SBFT, and which are difficult to diagnose by CT. There are many more indications for SBFT which I won't discuss. Enteroclysis is not for every patient and is usually done after a negative SBFT if strong clinical suspicions exist. It takes a better look at the SB mucosa and it's folds. We reserve enteroclysis for select cases only and we do about one or two a week. Doing a "high-quality" SBFT and especially enteroclysis studies are difficult to interpret and if you don't know what you're looking at (read at least 98%+ of current residents and recent graduates alike), you'll find them pretty worthless, in which case they would be.

Granted, the role of these studies will continue to decrease as MR and CT advances. There are now papers evaluating "MR enteroclysis". Although not exceedingly useful now, they will become the way of the future. The major problem with the utility of SBFTs and enteroclysis is that there are very few radiologists that know how to read them. Sometime ago, I saw one of my attendings diagnose cryoglobulinemia vs. radiation enteritis on a SBFT. The patient had not received XRT in the past. An extensive work-up ensued, including kidney biopsy. The final diagnosis was mixed cryoglobilinemia and MPGN type I glomerulonephritis. Kudos to the radiologist. The problem is that number of people capable of making these kinds of diagnoses on SBFT in the whole country is probably less that the number of fingers of your two hands.

 

[RADRULES]

I'm curious... who exactly is "the best". I trained under a legendary GI radiologist, and still do not find it worthwhile when you consider the time spent vs. diagnostic yield. Perhaps I could read a book by "the best" to increase my knowledge.

 

[Docxter]

There is no "the best". I have trained with four of the best full-time GI radiologists. Each has his own niche despite being amazing all-around in GI radiology. All four are world-renowned. One of them was the person who actually invented the current technique of enteroclysis. He retired last year. I just wish I had learned more from them, but I didn't. My loss.

 

[Crypt Abscess]

In terms of occult and obscure GI bleeding, Enteroclysis has higher diagnostic yield and sensitivity than SBFT. (Rockey DC, et al. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive FOBTs. N Engl J med 1998; 339: 153-9.)

I think there is also a ?tubeless enteroclysis? that is available at some big academic centers. The tube is probably the biggest disadvantage of enteroclysisI am not aware of any studies of SBFT vs. enteroclysis in IBD.

Crypt

 

[Docxter]

Originally posted by Crypt Abscess
In terms of occult and obscure GI bleeding, Enteroclysis has higher diagnostic yield and sensitivity than SBFT. (Rockey DC, et al. Relative frequency of upper gastrointestinal and colonic lesions in patients with positive FOBTs. N Engl J med 1998; 339: 153-9.)

Crypt

The article you mentioned doesn't say anything about enteroclysis or SBFT. It's not even about the small bowel!!!!!!!!