There is an increase of reliance on ileoscopy in preference to small-bowel barium follow-through in the diagnosis of terminal ileal Crohn disease.
Dr Soon and colleagues from London, England designed a study into the role of small-bowel barium follow-through after a normal or unremarkable ileocolonoscopy.
The research team conducted a retrospective analysis of all patients who had a colonoscopy followed by a small-bowel barium follow-through over a 7-year period was performed.
The researchers excluded all patients with a previously established diagnosis of inflammatory bowel disease and also those who had colonoscopic evidence of inflammatory bowel disease.
The researchers found that out of the total 96 patients who had a normal ileoscopy and normal or unremarkable colonoscopy, 3 had abnormalities detected at small-bowel barium follow-through.
The research team noted that 2 patients had abnormal terminal ileal biopsies, although the terminal ileum appeared macroscopically normal.
| Small-bowel barium follow through should only be performed if there is a very high index of suspicion of small-bowel pathology|
|Scandinavian Journal of Gastroenterology|
The researchers found that the small-bowel barium follow-through helped to establish the diagnosis of Crohn disease.
The other patient presented changes consistent with a previously established diagnosis.
The research group concluded that out of the 47 patients who had a normal or unremarkable total colonoscopy without ileoscopy, 1 had abnormalities detected at small-bowel barium follow-through consistent with a previously established diagnosis.
Dr Soon concluded, "Small-bowel barium follow-through is rarely required in patients who have had a normal ileoscopy and terminal ileum biopsy and a normal or unremarkable colonoscopy."
"It should only be performed if there is a very high index of suspicion of small-bowel pathology."
"In patients with suspected Crohn's disease, it is important to take terminal ileum biopsies even if the ileum appears macroscopically normal at ileoscopy."