Hydrosonography of the small intestine: Comparison with radiologic barium study

Background: Transabdominal ultrasonography of the small intestine is hamper ed by luminal gas. We have developed a new sonographic method (hydrosonogra phy) that largely eliminates the gas problem and have compared this method with radiologic barium study. Methods: Fifty-six patients admitted for X-ra y examination of the small bowel because of abdominal pain, diarrhoea, weig ht loss and/or known inflammatory bowel disease were examined. To remove lu minal gas before performing transabdominal ultrasonography, 2 l of polyethy lene glycol solution was inserted through a nasojejunal tube by means of a peristaltic pump. Wall thickness, peristalsis, luminal narrowing, prestenot ic dilatation, and extraintestinal complications were recorded. Results: On ultrasonography we were able to visualize the terminal part of the ileum i n 98% of the patients. Perfect agreement between hydrosonography and barium studies was seen in 50 of 55 patients. However, 44 patients had normal fin dings on both examinations. The sensitivity and specificity of hydrosonogra phy were 64% and 100%, respectively. The positive predictive value was 100% . For X-ray examination sensitivity and specificity were 91% and 100%, resp ectively. Four patients with minor mucosal abnormalities or pathologic find ings in the upper part of the small intestine accounted for the relatively low overall sensitivity found for hydrosonography compared with roentgenogr aphy. However, important extraintestinal complications were disclosed by ul trasound. Conclusions: Hydrosonography of the small bowel is a new, conveni ent, and reliable method for examining the lower part of the small intestin e. However, it cannot replace barium studies in patients with mucosal abnor malities, especially in the upper part of the small bowel.