Disadvantages of CTE and Pitfalls

Nasoenteric tube placement is necessary for infusion, but its associated discomfort is alleviated by the use of conscious sedation and smaller tubes [16]. Conscious sedation requires dedicated personnel and makes the procedure longer and more expensive. In small institutions and non-tertiary care facilities this may not be practical. In patients who require nasogastric suction and potentially need a small bowel examination, the initial use of a decompression/entero-clysis catheter circumvents this disadvantage [23].

The logistics of performing CT when the fluoroscopic suite is far from the CT area is a deterrent. The addition of CT to enteroclysis increases the cost of the procedure and exposure of radiation to patients and radiologic personnel. The procedure therefore should be done only when clinically indicated.

Fluoroscopy should be limited when utilizing positive enteral contrast CTE. When feasible, CTE should be used with neutral enteral and iv contrast.

Radiation doses related to CT enteroclysis remain a significant issue. The use of a multidetector CT with 40 or more channels can reduce radiation by 10-66% [24]. This is because of a more efficient detector configuration, automatic exposure controls, improved filters and image post processing algorithms. MR enteroclysis has the advantage of lack of radiation exposure and safer contrast agents, but appears to be less accurate than CT en-teroclysis. In a prospective comparison between MR en-teroclysis and CT enteroclysis, the latter showed greater sensitivity and interobserver agreement for an array of pathological signs of small bowel diseases [25].

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