Procedures in Gastrointestinal Radiology

238 Pages·1990·11.021 MB·English

by  Julian Dobranowski MD, David A. Stringer MD, Sat Somers MD, Giles W. Stevenson MD (auth.)

Procedures in
Gastrointestinal Radiology
J.
Dobranowski D.A. Stringer
S. Somers C.W. Stevenson
Procedures in
Gastroint es tinal
Radiology
With a Contribution by Lynne McLean
With a Foreword by William M. Thompson
With 175 Illustrations in 335 Parts
Springer-Verlag New York Berlin Heidelberg
London Paris Tokyo Hong Kong
JULIAN DOBRANOWSKI, MD
Staff Radiologist, St. Joseph's Hospital; Assistant Clinical Professor,
McMaster University, Hamilton, Ontario L8N 4A6, Canada
DAVID A. STRINGER, MD
Head, Ultrasound and Gastrointestinal Radiology, The Hospital fClr Sick
Children, Toronto, Ontario M5G lX8, Canada; Associate Professor,
University of Toronto
SAT SOMERS, MD
Head, Gastrointestinal Radiology, Chedoke-McMaster Hospitals, Associate
Professor, Department of Radiology, McMaster University, Hamilton,
Ontario L8N 3Z5, Canada
GILES W. STEVENSON, MD
Professor and Chairman, Department of Radiology, Chedoke-McMaster
Hospitals and McMaster University, Hamilton, Ontario L8N 3Z5, Canada
Contributor of Chapter 7:
LYNNE McLEAN, RT
Chief Technologist, Department of Radiology, Chedoke-McMaster
Hospitals, McMaster Division, Hamilton, Ontario L8N 3Z5, Canada
On the front cover: Fig. 3.14 B see p. 55; Fig. 6.11 see p. 175.
Library of Congress Cataloging-in-Publication Data
Procedures in gastrointestinal radiology/J. Dobranowski ... ret al.l
; with a contribution by Lynne McLean; with a foreword by William
M. Thompson.
p. cm.
Includes bibliographical references.
ISBN-13: 978-1-4612-7961-7 e-ISBN-13: 978-1-4612-3308-4
DOl: 10.1007/978-1-4612-3308-4
1. Gastrointestinal system-Diseases-Diagnosis.
2. Gastrointestinal system-Radiography. 3. Gastroscopy.
I. Dobranowski, J. (Julian)
[DNLM: 1. Gastrointestinal System-radiography. 2. Technology,
Radiologic. WI 141 P9631l
RC804.R6P76 1990
616.3'30T57-dc20
DNLMIDLC
for Library of Congress 89-21752
© 1990 Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1990
All rights reserved. This work may not be translated or copied in whole or in part without
the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth
Avenue, New York, NY 10010, USA), except for brief excerpts in connection with
reviews or scholarly analysis. Use in connection with any form of information storage
and retrieval, electronic adaptation, computer software, or by similar or dissimilar meth
odology now known or hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication,
even if the former are not especially identified, is not to be taken as a sign that such
names, as understood by the Trade Marks and Merchandise Act, may accordingly be
llsed frcely by anyone.
While the advice and information in this book is believed to be true and accurate at the
date of going to press, neither the authors nor the editors nor the publisher can accept
any legal responsibility for any errors or omissions that may be made. The publisher
makes no warranty, express or implied, with respect to the material contained herein.
Typeset by TCSystems, Inc., Shippensburg, Pennsylvania.
9 8 765 4 3 2 1
J. DOBRANOWSKI To Jolanta, Magdalena, Alexander, and to
my parents
D.A. STRINGER To my wife and children, Judy, Charles,
Rosemary, and Henry, and to my parents
S. SOMERS To my wife Susan and children, Kris and
Vijay
C.w. STEVENSON To CI technologists, radiology residents
and CI radiology fellows who over the
years have stimulated my interest in this
subject
Foreword
Dr. Dobranowski and his associates are to be highly commended for
this excellent manual. I am not aware of a similar text covering the
subject. Although all of us perform gastrointestinal studies in a differ
ent manner, this text provides an excellent overview. The reader will
discover that the text is especially well written and focuses on the
important issues relating to GI contrast studies. Because Dr. Steven
son's group performs endoscopic procedures, they are included in the
manual.
These authors are recognized scholars and leaders in gastrointesti
nal radiology. Thus, it is easy to understand why the manual is so well
done. I am particularly impressed with the emphasis placed on the
patient-radiologist relationship before, during, and after completion
of a study.
All of us who teach gastrointestinal radiology are concerned about
the decline in the number of gastrointestinal contrast studies. We are
not sure how we can continue to teach our residents the proper tech
niques and maintain high-quality teaching programs in gastrointesti
nal radiology. A manual of this type is thus timely and appropriate. The
manual will be a valuable addition to the library of all radiologists. It
will be particularly useful for residents who are learning how to per
form GI contrast studies.
WILLIAM M. THOMPSON, MD
Professor and Chairman
Department of Radiology
University of Minnesota
Minneapolis, MN 55455
Preface
Modern medicine, with its emphasis on early disease detection and
treatment, has set new goals for modern gastrointestinal radiology. To
be able to make early and accurate diagnoses, radiologists must be
acquainted with the various imaging techniques and be able to select
the most appropriate study f()r the presenting clinical problem. The
introduction of fiberoptic endoscopy has revealed many shortcomings
in gastrointestinal imaging, but this knowledge has subsequently led
to improvements in the accuracy of barium studies.
Endoscopy has become the primary method of imaging in some
situations, but quality barium radiology remains the initial investiga
tion of choice f()r routine colon examination, f(lr esophageal symptoms,
and for most small bowel disease. For gastric and duodenal disease,
barium radiology can be almost as accurate as endoscopy in coopera
tive patients and is often much cheaper. There remains a clinical need
for high-quality barium radiology.
The purpose of this book is to provide a detailed step-by-step de
scription of the various examinations in GI radiology, with emphasis
on the barium studies that have primary indications and have been
proven to provide the most useful and accurate clinical information.
Endoscopic procedures have also been described in the hope that a
knowledge of endoscopy will allow the radiologist a more thorough
understanding of barium examinations and also allow for a closer inter
action between radiology and endoscopy.
We hope that the step-by-step approach of the book will help clarify
practical aspects of the various techniques, making it useful to radiol
ogy residents and technologists as well as a valuable reference f(lr
practicing radiologists.
Acknowledgments. We would like to thank Monika Ferrier for her
advice and unending help in the preparation of the manuscript. We
thank Richard F. Zazulak f()r his excellent illustrations, and E-Z-Em
Canada, Winthrop Canada, Cook Canada, and Lafayette Canada for
their generous financial support. Special thanks to the production and
editorial staff of Springer-Verlag for all their work and excellent advice.
J.
DOBRANOWSKI
D.A. STRINGER
S. SOMERS
C.W. STEVENSON
Contents
Foreword. WILLIAM M. THOMPSON ................................................ vii
Preface............................................................................................. ix
1 Introduction............................................................................... 1
References................................................................................. 2
2 Upper Gastrointestinal Tract.................................................... 3
Routine Barium Meal................................. ............................... 3
Indications............................................................................. 3
Contraindications and Precautions....................................... 4
Materials................................................................................. 4
Patient Preparation................................................................ 5
Esophageal Examination for Specific Problems ...................... 24
Suspected Gastroesophageal Reflux (Water
Siphon Test) ........................................................................... 24
Globus Hystericus .......................... ......... ............ .................. 25
Dysphagia.............................................................................. 26
Chest Pain.............................................................................. 29
Acute Total Dysphagia .......................................................... 30
Perforation.............................................................................. 30
Tube Esophagram ....... ............................. ...... ...... ................. .... 30
Indications............................................................................. 30
Contraindications and Precautions....................................... 30
Materials................................................................................. 31
Patient Preparation ................................................................ 31
Postoperative Examination... ........ ............... ......... .................... 32
Indications and Choice of Technique .................................. 32
Technique of Upper Gastrointestinal Endoscopy................... 35
Radiologists and Endoscopy.. .......... ................ ..................... 35
Diagnostic Technique ........................................................... 36
Provision of an Endoscopy Service ...... .............. .................. 38
Evaluation of Swallowing Function and the Palate ................ 38
Evaluation of Swallowing Function ...... .......... ...... ............... 38
References................................................................................. 39
xii Contents
3 Small BoweL ............................................................................. . 43
Small Bowel Meal .................................................................... . 43
Double-Contrast Small Bowel Examination ........................... . 47
Small Bowel Enema (Enteroclysis) ......................................... . 47
Peroral Pneumocolon ........................................................... . 56
Small Bowel Follow-Through .............................................. . 56
Reflux Small Bowel Enema .................................................. . 57
Postoperative Small Bowel .................................................. . 58
References ................................................................................ . 60
4 Large Bowel ............................................................................. . 61
Double-Contrast Barium Enema ............................................. . 61
Theoretical Concept ............................................................. . 64
Technique of Examination ................................................... . 68
Examination of Remainder of Colon .................................. .. 72
Single-Contrast Barium Enema ............................................... . 78
Instant and Air/C0 Enemas ............................................... . 84
2
Air Enema ............................................................................. . 84
Flexible Sigmoidoscopy .......................................................... . 85
Colonoscopy ............................................................................. . 87
Defecography (Evacuating Proctography) .............................. . 93
Defecography Throne .......................................................... . 96
Postoperative Colon ................................................................. . 99
Early Postoperative .............................................................. . 99
Late Postoperative ................................................................ . 100
Cancer and Polyp Follow Up: Barium Enema or
Colonscopy ............................................................................ . 102
References ................................................................................ . 103
5 Pediatric Gastrointestinal Examinations ................................. . 107
Introduction .............................................................................. . 107
Sonography ............................................................................... , 107
Indications for Examination ................................................. . 108
Preparation for Sonographic Examinations ........................ .. 114
Upper GI Contrast Examinations in Children ....................... . 115
Feeding Study ...................................................................... . 115
Swallowing Study ................................................................. . 117
Speech Study ........................................................................ . 118
Standard Single-Contrast Barium Mea!.. ............................. . 123
Video Prone Esophagram ..................................................... . 128
Double-Contrast Examination of the Esophagus,
Stomach, and Duodenum ..................................................... . 129
Single-Contrast Small Bowel Meal and Follow-Through .. . 134
Peroral Pneumocolon ........................................................... . 136
Small Bowel Enema ............................................................. . 137
Water-Soluble Contrast Meal ............................................... . 139
Lower GI Tract Contrast Examinations in Children .............. . 141
General Considerations ........................................................ . 141
Single-Contrast Enema: Choice of Contrast Media ........ . 142
Water-Soluble Enema in Neonates .................................. . 143
Single-Contrast Barium Enema ........................................ . 145
Intussusception Reduction ............................................... . 146
Contents xiii
Loopogram.......................................................................... 150
Double-Contrast Barium Enema....................................... 152
Defecogram ........................................................................ 155
Miscellaneous............................................................................ 158
Intestinal Tube Placement.................................................... 158
Foreign Body Removal.......................................................... 159
References ................................................................................. 161
6 Special Procedures ...... ...... ... ... ........... ... ...... .......... .................... 167
Sinograms and Fistulograms..................................................... 167
Oral Cholecystography: Operative and Postoperative
Cholangiography................... ... ................. .......... ... .... ............... 169
Oral Cholecystography........................... ...... .......... ... ............ 169
Operative and Postoperative Cholangiography................... 172
Liver Biopsy..... ......... ... ...... .............. ... ... ...... ................ ......... .... 173
Percutaneous.......................................................................... 173
Transjugular ........................................................................... 177
Percutaneous Transhepatic Cholangiography (PTC) .............. 182
Endoscopic Retrograde Cholangiopancreatography ........... .... 188
Diagnostic ERCP .................................... .......................... ..... 188
Endoscopic Sphincterotomy (ES) ......................................... 190
Stents ...................................................................................... 192
Combined Techniques .......................................................... 192
GastrostonlY ............................................................................... 19.3
Radiological ........................................................................... 193
Endoscopic............................................................................. 195
Computed Tomography............................................................ 196
Esophagus .............................................................................. 197
Stomach and Duodenum ....................................................... 198
Small Bowel................................. ......... ... ............ ... ............... 200
Colon and Rectum ................................................................. 201
Pelvis ...................................................................................... 203
Liver ....................................................................................... 203
Pancreas ................................................................................. 203
References................................................................................. 206
7 Technical Aspects of Imaging of the Gastrointestinal Tract
LYNNE McLEAN.......................................................................... 209
The Technologist's Role ........................................................... 209
Organization........................................................................... 209
Radiation Protection.............................................................. 209
Patient Preparation ................................................................ 210
Communication...................................................................... 210
Technical Factors and Equipment........................................... 211
Grid ........................................................................................ 211
Film/Screen Combination .................................................... 211
High-kV Techniques (Kilovolts) ........................................... 211
The Barium Kitchen.................................................................. 212
Specific Tips for Technologists During a Barium Enema... 213
During the Examination .................................................... 213
Overheads........................................................................... 213
Specific Radiographs.......................................................... 213
XIV Contents
8 Pharmacology ............................................................................ 217
References................................................................................. 220
Appendixes
I Products and Manufacturers.................................................... 221
II Further Reading....................................................................... 223
Index ............................................................................................... 225