Individualized Small Bowel Preparation For Computed Tomography Enterography

BackgroundComputed tomography enterography(CTE),depending to a large extent on sufficient luminal distention with oral contrast agent,is currently the accurate imaging technique for the evaluation of patients suspected of having or known to have small bowel diseases(IBD).Most enterographic researches used 135 0-1500 mL neutral contrast agents for adequate small bowel distention.However,it was found that the conventional volume of contrast agent ingestion was often unsatisfactory regarding either small bowel distention or patients’ acceptance in practice.The establishment of individualized bowel preparation will achieve consistently safe,acceptable and high-quality examinations and thus enable better assessment of small bowel diseases.Therefore,generating individualized small bowel preparation is necessary.According to our clinical experience,conventional volume of oral agent administration sometimes lead to failure in CTE for those who are thin and weak because of poor patients’ acceptance,or for those who are obese because of unsatisfactory bowel distention quality.Given that body mass index(BMI)is a widely accepted risk factor in inadequate bowel cleanliness for colonoscopy and some studies have reported a positive correlation between small intestinal length and BMI,it may be also an independent factor associated with the quality of small bowel distention in CTE.PurposeTo evaluate the feasibility of BMI based individualized small bowel preparation for CTE.MethodsBetween January 2019 and September 2019,patients undergoing CTE were randomly assigned to the individualized group(group A)or standardized group(group B).Those in individualized group were given different volume of mannitol solution based on BMI(1000 mL for patients with BMI<18.5 kg/m2,1500 mL for patients with 18.5 kg/m2≤ BMI<25 kg/m2 and 2000 mL for patients with BMI≥25 kg/m2),while patients in standardized group were all asked to consume 1500 mL mannitol solution.CTE images were reviewed by two experienced radiologists blindly.Each segment of the small bowel was assessed for small bowel image quality and diseases detection rates.Patients were also invited to record the adverse events and acceptance.ResultsCTE was performed in 215 consecutive patients,with 203 of them being enrolled according to the predetermined inclusion and exclusion criteria.186 patients were finally analyzed.No differences were found between group A and B regarding Patients’ demographic data.For patients with BMI<18.5 kg/m2,the mean score for overall image quality in group A1 and group B1 were both above the "good" levels(3.11±0.81 vs.3.33±0.69,P=0.363).The detection rate of small-bowel diseases was high in group A1 than that in group B1(100.0%vs.75.0%).Mannitol solution showed overall good image quality in both group A2 and group B2(3.11 ±0.89 vs.3.02±0.85,P=0.620).For patients with BMI≥25 kg/m2,the ingestion of 2000 mL oral solution resulted in significantly better overall image quality compared with that achieved by conventional dosage(3.03±0.76 vs.2.62±0.67,P=0.033).In addition,the detection rate of small-bowel diseases was high in group A3 than that in group B3(80.0%vs.66.7%).There was no statistically significant difference with regard to overall image quality between group A and group B,of which more of the individualized cases were considered as ’adequate’ compared with standardized cases,but this difference was not significant at the 5%level(74.2%vs.69.9%,P=0.624).The degree of flatulence(P=0.045)and defecating frequency(P=0.011)was significantly higher in group B1 than that of group A1.There were no statistically significant differences with respect to the rates of all kinds of adverse events between group A2 and group B2 or group A3 and group B3.The acceptance score was significantly higher in group A1 than that of group B1(P=0.015),but no significant differences were found between group A2 and group B2 or group A3 and group B3.ConclusionsIndividualized bowel preparation could achieve both satisfactory image quality and patients’ acceptance,thus might be an acceptable alternative in CTE.