The Effects of Erythromycin in Small-Bowel Follow-through

PURPOSE: To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). MATERIALS AND METHODS: We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. RESULTS: Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspen-sion and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4 points), but mean SBTT was not sig-nificantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. CONCLUSION: EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

Small Bowel Enteroclysis Using a Hemodialysis Blood Pump

PURPOSE: To describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. MATERIALS AND METHODS: Over a 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in132 patients using a hemodialysis blood pump. Following intubation of the proximal jejunum, barium at a dilutionof 50% and 0.5% methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spotfilms of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopitime and complications were evaluated. RESULTS: Only two of 135 examinations (1.5%) failed due to lack ofcooperation by the patient. Rates of good distensability were 97.6% in the proximal portion, 91.2% in the minportion and 52% in the distal portion and rates of good transparency were 96%, 84% and 56% respectively.Transparency and distensability of the small intestine were better in proximal than distal small bowel. Theradiographs showed positive findings in 25% of cases. The mean fluoroscopic time was 21 min, 10 sec(8min,22sec-57min, 30sec). No major complication was found during or after exam ination. CONCLUSION: It spite of thelong fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation ofsmall bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographsof good quality.