Enteroklizis
Özet
Enteroklizis, ince bağırsak hastalıklarının teşhisinde kullanılan, nazojejunal tüp aracılığıyla baryum veya metilselüloz gibi kontrast maddelerin doğrudan verilmesini içeren ileri bir radyolojik görüntüleme tekniğidir. Bu yöntem, özellikle mekanik ince bağırsak tıkanıklıklarının etiyolojisini belirlemede, düşük dereceli obstrüksiyonları saptamada ve adezyonları malignite gibi durumlardan ayırt etmede yüksek güvenilirlik sunar. Ayrıca, ince bağırsak neoplazmalarının evrelemesinde ve kronik radyasyon enteritinin yönetiminde geleneksel pasaj grafilerine göre çok daha duyarlı sonuçlar verir; örneğin tümör saptama duyarlılığı %90'a kadar çıkabilmektedir. Ancak invaziv doğası, hasta toleransının düşük olması ve uygulama zorluğu nedeniyle günümüzde klasik enteroklizisin yerini giderek daha fazla BT ve MR enterografi gibi non-invaziv teknikler almaktadır. Bu modern yöntemler, Crohn hastalığı gibi kronik durumlarda bağırsak duvarının ve lümeninin daha konforlu bir şekilde değerlendirilmesine olanak tanır. Teknolojik gelişmeler, klinisyenlerin ve radyologların daha hızlı, kesin ve hastalar için daha az yorucu olan bu yeni nesil görüntüleme tetkiklerini tercih etmesini sağlamaktadır.
Enteroclysis is an advanced radiological imaging technique used in the diagnosis of small bowel diseases, involving the direct administration of contrast agents such as barium or methylcellulose through a nasojejunal tube. This method offers high reliability, especially in determining the etiology of mechanical small bowel obstructions, detecting low-grade obstructions, and differentiating adhesions from conditions like malignancy. Additionally, it provides much more sensitive results compared to traditional follow-through examinations in the staging of small bowel neoplasms and the management of chronic radiation enteritis; for instance, its sensitivity for tumor detection can reach up to 90%. However, due to its invasive nature, low patient tolerance, and difficulty in application, classic enteroclysis is increasingly being replaced today by non-invasive techniques such as CT and MR enterography. These modern methods allow for a more comfortable evaluation of the intestinal wall and lumen in chronic conditions like Crohn's disease. Technological advancements are enabling clinicians and radiologists to prefer these next-generation imaging tests, which are faster, more precise, and less strenuous for patients.
Referanslar
Mullan CP, Siewert B, Eisenberg RL. Small bowel obstruction. AJR Am J Roentgenol 2012; 198:W105.
Shrake PD, Rex DK, Lappas JC, et al. Radiographic evaluation of suspected small bowel obstruction. Am J Gastroenterol 1991; 86:175.
Kohli MD, Maglinte DD. CT enteroclysis in incomplete small bowel obstruction. Abdom Imaging 2009; 34:321.
Caroline DF, Herlinger H, Laufer I, et al. Small-bowel enema in the diagnosis of adhesive obstructions. AJR Am J Roentgenol 1984; 142:1133.
Paulsen SR, Huprich JE, Fletcher JG, et al. CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 2006; 26:641.
Mullan CP, Siewert B, Eisenberg RL. Small bowel obstruction. AJR Am J Roentgenol 2012; 198:W105.
Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics 2009; 29:1811.
51. American College of Radiology (ACR) Appropriateness Criteria on suspected small-bowel obstruction. Available at: https://acsearch.acr.org/docs/69476/Narrative/ (Accessed on July 24, 2019).
Bender GN, Timmons JH, Williard WC, et al. Computed tomographic enteroclysis: one methodology. Invest Radiol 1996; 31:43.
Maglinte DD, Bender GN, Heitkamp DE, et al. Multidetector-row helical CT enteroclysis. Radiol Clin North Am 2003; 41:249.
Schmidt S, Lepori D, Meuwly JY, et al. Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of "sign-by-sign" correlation. Eur Radiol 2003; 13:1303.
Nolan DJ. The true yield of the small-intestinal barium study. Endoscopy 1997; 29:447.
Bessette JR, Maglinte DD, Kelvin FM, et al. Primary malignant tumors in the small bowel: a comparison of the small-bowel enema and conventional follow-through examination. AJR Am J Roentgenol 1989; 153:741.
Maglinte DDT, Lappas JC, Kelvin FM, et al. Small bowel radiography: how, when and why? Radiology 1987;163:297-305
Van Weyenberg SJ, Meijerink MR, Jacobs MA, et al. MR enteroclysis in the diagnosis of small-bowel neoplasms. Radiology 2010; 254:765.
Boudiaf M, Jaff A, Soyer P, et al. Small-bowel diseases: prospective evaluation of multi-detector row helical CT enteroclysis in 107 consecutive patients. Radiology 2004; 233:338.
Bender GN, Maglinte DD, Klöppel VR, et al. CT enteroclysis: a superfluous diagnostic procedure or valuable when investigating small-bowel disease? AJR Am J Roentgenol 1999; 172:373.
Orjollet-Lecoanet C, Ménard Y, Martins A, et al. [CT enteroclysis for detection of small bowel tumors]. J Radiol 2000; 81:618.
Maglinte DD, Bender GN, Heitkamp DE, et al. Multidetector-row helical CT enteroclysis. Radiol Clin North Am 2003; 41:249.
Pilleul F, Penigaud M, Milot L, et al. Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 2006; 241:796.
