Jpn J Radiol (2011) 29:673681

DOI 10.1007/s11604-011-0621-7

REVIEW

Computed tomography enteroclysis: a review

Palle Lalitha M. Ch. Balaji Reddy
K. Jagannath Reddy M. Vijaya Kumari

Received: October 12, 2010 / Accepted: June 23, 2011

Japan Radiological Society 2011

Abstract
Computed tomography (CT) enteroclysis is being performed routinely for evaluation of suspected small
bowel diseases. The availability of multidetector CT
scanners has further increased the diagnostic yield of
enteroclysis. There is excellent depiction of small
bowel wall pathol- ogy on CT enteroclysis especially
with use of negative enteric contrast. We discuss the
CT enteroclysis tech- nique and procedure along with
the imaging spectrum of some common small bowel
pathologies.
Key words Computed tomography Enteroclysis
Crohns disease Small bowel obstruction Small
bowel neoplasm

Introduction
The small bowel is the only part of the gastrointestinal
system that had been inaccessible to endoscopy until
recently. The long length of the small bowel makes it
difficult for complete and adequate assessment. In an
adult, the average length of the small bowel is 600 cm
(range 260800 cm).1
Traditionally, barium meal follow-through (BMFT)
used to be performed to evaluate the entire length of the
small bowel, but patients may find it difficult to drink

P. Lalitha (*) M.Ch.B. Reddy K.J. Reddy

Department of Radiology, Focus Diagnostics, Dwarakapuri
Colony, Punjagutta, Hyderabad 500082, Andhra Pradesh, India
Tel. 91-40-23351818
e-mail: lalithamanohar@rediffmail.com
M.V. Kumari
Department of Radiology, Osmania Medical College,
Hyderabad (AP), India

enough barium to adequately opacify the entire small

bowel. BMFT also gives no direct extraluminal
informa- tion. It is also time-consuming, as the patient
has to wait until the barium reaches the ileocecal
junction. Despite these limitations, it was extensively
used because of its easy availability, low cost, and
simplicity.
Conventional barium enteroclysis was found to be
more accurate and reliable for evaluating the small
bowel, but because it is invasive there is less patient
toler- ance than for BMFT. Also, there is a high
radiation dose to both doctor and patient; and only
indirect informa- tion about adjacent structures can be
obtained. It is a two-dimensional modality, and it may
difficult to distin- guish the overlapping bowel loops.
The advent of computed tomography (CT) during the
1980s revolutionized abdominal imaging. Not only the
bowel but extraluminal structures and organs can be
evaluated in the same sitting. Comparative studies
between BMFT and CT proved the superiority of CT
for demonstrating small bowel and extraluminal pathology.2 However even on a routine examination, poor
bowel distention is a problem, and subtle/early wall and
mucosal changes may be missed.
Computed tomography (CT) enteroclysis is an
imaging technique that is dedicated to studying the
small bowel and combines enteroclysis and helical CT,
thereby giving a better depiction of mucosal and wall
abnormalities and fistulas, among other problem situations.
Materials and methods
Patient preparation
The patient preferably consumes a low-residue diet the
day before the study and is given nothing orally on the

day of the examination. A laxative may be given a day

prior to the examination to avoid a loaded large bowel.
Generally, sedation is not necessary, but anxious
patients may require conscious sedation (oral
diazepam). We usually prefer not to give any sedative
to the patient. Prior explanation of the entire
procedure to the patient with counseling usually
alleviates any apprehension.
Technical requirements and protocol
The CT enteroclysis is preferably performed with multislice (64 slice) CT to facilitate good multiplanar reconstruction. At our center we normally use a peak voltage
of 120 kVp and 120 mAs with a reconstruction
thickness of 3 mm. Intravenous nonionic contrast
material (6570 ml) is administered at the rate of 2.5
ml/s. We use 1.52.0 liters of methylcellulose as oral
contrast agent, depending on patient comfort, tolerance,
and bowel dis- tention. We routinely acquire images in
the portal venous phase (7090 s after contrast
administration) to achieve adequate bowel wall
enhancement. A plain scan is per- formed initially
after administration of enteric contrast to assess the
adequacy of bowel distention. If necessary, more
methylcellulose is given to the patient. This initial plain
scan also serves as a scout to look for abnormali- ties
and helps us tailor the study. Best results are obtained
by tailoring the procedure based on the patients
require- ments and pathology. If there are focal liver
lesions, we then also perform arterial phase scans to
evaluate and characterize the liver lesions during the
same scan. Optimal bowel distention is a must for CT
enteroclysis. Bowel distention is considered optimal
when the diam- eter of the jejunum is 3 cm and the
ileum is 2.5 cm.3
Contrast material
For bowel opacification we can use any of the following.
Neutral contrast agentwater, methylcellulose
(mucosal and wall abnormalities can be seen well).
Mannitol also can be used. The large volume of enteric
contrast material is eliminated rectally before significant absorption occurs. The disadvantage of using
water is that it may be absorbed and may lead to
inadequate bowel distention. Increased lesion conspicuity is seen after intravenous contrast administration,
when neutral enteric contrast is administered.
Negative contrast agentair (mainly used
for stomach,
duodenum, and colon). Not being used routinely.
Positive contrast agentdiluted barium sulfate or
oral contrast material (preferred in cases of leaks,

low- grade obstruction, or when there is

contraindication for an intravenous contrast agent)

We use methylcellulose routinely as it gives

adequate bowel distention for a longer period of time
than water. Water can be used if an enteroclysis
catheter with balloon is used to prevent reflux into
the stomach. Intravenous glucagon is administered to
the patient when water is used as it reduces
peristalsis. Nonionic contrast agent is preferably used
for intravenous injection.
Procedure
CT enteroclysis involves two phases.
1. Fluoroscopic phase: The nasojejunal catheter tip
is positioned to the left of the spine (at the
duodeno- jejunal flexure or beyond) under
fluoroscopic guidance.
2. CT phase: After tube placement in the
fluoroscopy room, the patient is shifted to the CT
room. Enteric contrast material is then infused by
either a pressure- controlled pump or hand injection
(150200 ml/min).
Various types of catheters are in use, such as the
entero- clysis catheter (12F or 13F), Bilbao-Dotter
tube, Nolan tube with pump combination, and a
variety of nasojeju- nal tubes.

There are a few common procedural problems that

may be encountered while placing the tube. There may
be difficulty in the region of the gastric fundus and
when navigating the pylorus. Metoclopromide 10 mg
p.o. 20 min before the procedure or intravenously at the
beginning of intubation has also been described.4 For
difficult cases, we have sometimes administered a few
milliliters of ionic oral contrast material to locate the
pylorus so the tube can be guided toward it. The guidewire must not be pushed across the pylorus. Another
problem encountered during CT enteroclysis is inadequate distention of the ileum. This can be overcome by
placing the patient in the prone position or by using a
compression device.5
Indications
Some of the common indications for CT enteroclysis are
Crohns disease/inflammatory diseases, small bowel
obstruction/strictures, infectious diseases, small bowel
neoplasms, obscure gastrointestinal bleeds (second-line
role), adhesions (visceral and parietal), and miscellaneous disorders.
Crohns disease
Crohns disease is a transmural granulomatous disease
of the gastrointestinal tract with extraintestinal involve-

Fig. 1. Crohns disease. Coronal computed tomography (CT)

enteroclysis image from a 45-year-old man shows diffuse longsegment wall thickening of the small bowel with wall hyperemia
(arrows) and mesenteric fibrofatty proliferation

Jpn J Radiol (2011) 29:673681

Fig. 3. Crohns disease. Coronal CT enteroclysis image from a

52-year-old man shows diffuse long-segment wall thickening of
the small bowel with wall hyperemia, mesenteric fibrofatty
prolifera- tion (short arrows), and the comb sign (long
arrow)

Fig. 2. Crohns disease. Coronal CT enteroclysis image from a

30-year-old man shows the target appearance of the small bowel
wall (arrow)

Fig. 4. Crohns disease. Sagittal CT enteroclysis image from a

38-year-old man shows an enteroenteric fistula (arrow)

ment. Active and chronic Crohns disease along with its

complications can be excellently demonstrated on CT
enteroclysis, thereby facilitating early diagnosis and
prompt treatment.
Features of active Crohns disease include bowel wall
thickening, mucosal hyperenhancement (Fig. 1)
[mucosal
hyperenhancement
is
defined
as
hyperattenuation in the bowel wall (when mural
stratification is absent) or of the inner aspect of the
bowel wall (when mural stratification is present), as
compared with the mural attenuation of adjacent small
bowel loops], hyperemia (target appear- ance) (Fig. 2),
adjacent mesenteric fibrofatty prolifera- tion (Fig. 3),
and prominent vasa recta (Comb sign). The

target sign is due to enhancing mucosa and outer muscular and serosal layers with intervening lowattenuating submucosal edema sandwiched between
the enhancing layers. It represents active inflammation.
When positive oral contrast is used, the mucosal
enhancement cannot be detected well. Almost all
patients with Crohns disease have a variable amount of
small-volume mesenteric lymphadenopathy. Among
the findings on CT entero- clysis, mural enhancement
has the highest sensitivity (80%) for predicting active
disease.6
Complications include abscesses, bowel loop clumping, fistulas/sinuses (Fig. 4). and end-stage strictures
(Fig. 5), which can be well demonstrated on CT entero-

Fig. 5. Crohns disease. Coronal CT enteroclysis image in a 60year-old man shows a short-segment smooth small bowel stricture with a thickened wall (arrow)

Fig. 6. Ileocecal tuberculosis. Coronal CT enteroclysis image

shows mild hyperemic wall thickening involving the cecum and
terminal ileum (arrows)

clysis. Mesenteric fibrofatty proliferation is almost

pathognomonic for Crohns disease and is easily recognized on CT. Fistulas are seen as hyperenhancing tracts
extending from the bowel to adjacent structures. Sinus
tracts resemble fistulous tracts but do not extend to other
structures and are blind-ending. Abscesses are well marginated extraluminal fluid collections with enhancing,
well-defined walls. Phlegmons are extraenteric masses
of fluid and soft-tissue attenuation with no discernible
margins. Strictures are seen as focal short segment nondistensible areas with or without intervening dilated
bowel segments. Any part of the gastrointestinal system
can be involved, with multiple areas and skip lesions.
Infectious diseases
One of the common infectious pathology of the small
bowel is tuberculosis, the most common CT finding of
which is bowel wall thickening, especially in the
terminal ileum, with or without ascites. Focal,
smooth, short- segment strictures can be seen in the
small bowel with or without associated ileocecal
junction involvement (Fig. 6).7 Strictures can be
solitary
or
multiple.
Involvement of
other
organsliver and spleen granulomas, omental/
peritoneal
nodularity
(Fig.
7),
lymphadenopathymay be detected. The
mesenteric fibrofatty proliferation seen in Crohns
disease is not usually seen in tuberculosis. A host of
parasitic, bacterial, and viral infections can involve
the small bowel and usually present with non- specific
small bowel wall thickening. Giardia and Strongyloides infections usually involve the duodenum
and jejunum.

Fig. 7. Abdominal tuberculosis. Coronal CT enteroclysis image

shows multiple areas of small bowel thickening (arrows)
with ascites and peritoneal nodules (arrowheads)

Small bowel obstruction/strictures

The diagnostic yield of CT enteroclysis in patients with
low-grade small bowel obstruction is much better than
conventional CT, with a sensitivity and specificity of
89% and 100%, respectively (Fig. 8).5
Adhesions are the cause of obstruction in 60%80%
of patients and can be well demonstrated with CT
enteroclysis. Findings that suggest the presence of adhesions include fixation and deformity of a small bowel
loop with loss of adjacent fat plane and kinking or sharp
angulations with wall thickening. Information regarding
the exact number and length of strictures (Fig. 5) can be

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Jpn J Radiol (2011) 29:673681

Fig. 8. Small bowel stricture. Coronal CT enteroclysis image

shows an ileal stricture (single arrow) with a thickened wall,
causing proximal obstruction in the form of dilatation and stasis
(double arrows)

obtained, thereby facilitating correct treatment decisions. CT enteroclysis is especially useful in cases of
suspected intermittent small bowel obstruction, where
peroral methods of bowel distention may not be adequate or informative. In such cases, volume challenging
the small bowel by enteroclysis is more useful for establishing the diagnosis. CT is accurate for diagnosis of
high-grade partial small bowel obstruction; it has a relatively lower sensitivity of 48%, however, for diagnosing
low-grade partial small bowel obstructions.8
The CT enteroclysis procedure is especially useful
when it is difficult to identify the transitional zone on
conventional CT scans in cases of intermediate- to lowgrade obstructions. In this setting, volume challenging
the proximal bowel can help identify the transitional
zone and make a diagnosis.9 If the point of obstruction
is not reached in cases of high-grade obstruction,
delayed images at 3 and 14 h may be necessary.10
Walsh et al. have found that CT enteroclysis is better
than routine CT scanning for detecting bowel
obstruction, especially in patients with a previous
malignancy.11
Small bowel neoplasms
Small bowel tumors are relatively uncommon and
present with nonspecific complaints such as pain, bleeding,
anorexia,
weight
loss,
and
sometimes
obstruction.12,13 Adenocarcinoma is the most common
small bowel tumor followed by carcinoid tumor,
lymphoma, and gastrointestinal stromal tumor.12 CT
demonstrates small bowel abnormalities associated
with tumors in 90% of

Fig. 9. Coronal CT enteroclysis image shows a small, homogeneously enhancing submucosal lesion. It was operated on and
found to be a leiomyoma (arrow)

patients.14,15 In view of excellent bowel loop distention

achieved with CT enteroclysis, it is superior to conventional CT in demonstrating small mucosal and wall
lesions (Fig. 9). The exact extent of the lesion and the
intra- and extraluminal components can be well delineated with contrast-enhanced CT enteroclysis. Small
enhancing lesions such as carcinoids can especially be
well picked up with CT enteroclysis compared to conventional CT. In a study conducted by Kamaoui et al.,
carcinoids as small as 5 mm could be detected.16
Adequate bowel distention caused by the negative
contrast allows good visualization of even small areas of
enhancement in the wall or lumen. Romano et al. concluded that multidetector CT enteroclysis with intravenous and neutral enteric contrast is a reliable imaging
technique for diagnosing small bowel neoplasms.17
Obscure gastrointestinal bleed
Obscure gastrointestinal (GI) bleed is defined as
bleeding that occurs when the upper and lower GI
endoscopy are negative (i.e.. do not reveal any cause of
the bleed).18 CT enteroclysis is not the primary
modality for diagnosing a GI bleed, although in a few
cases it may reveal the cause of the bleed (Fig. 10).
Most investigators prefer to perform CT in arterial and
portal venous phases when investigating for an
obscure GI bleed and follow it up with a delayed scan
if necessary.19 Early draining veins and vascular tufts
can be recognized in the arterial phase, whereas bowel
wall enhancement and neoplasms can be better seen in
the portal venous phase.20 Contrast pooling may be
observed with the delayed scans.

Fig. 10. Arteriovenous malformation. Coronal CT enteroclysis

image from a 45-year-old man with melena reveals tortuous
vessels in the jejunal wall (short arrow) and adjacent
mesentery (long arrow). At surgery it was proved to be a
bowel and mesenteric arteriovenous malformation

Some common causes of obscure GI bleeds are

angio- dysplasia, neoplasms, small bowel ulcers of
various causes, diverticula, vasculitis, and Meckels
diverticu- lum. Angiodysplasia is a common cause of
obscure GI bleed.6 On CT enteroclysis, they may
appear as a small focal nodular or plaque-like area of
enhancement in the bowel wall. Most of the lesions
enhance in the portove- nous phase, although some of
the less common high-flow lesions enhance in the
arterial phase.18 Small bowel tumors are responsible for
5%10% of all cases of small bowel bleeding.18
The CT enteroclysis procedure has been proved to be
more accurate than capsule endoscopy for detecting
sub- mucosal lesions.20 Korman et al. studied 62 patients
with an obscure GI bleed and concluded that CT
enteroclysis is definitely useful in cases of obscure GI
bleed.21 Khalife et al. compared 64-slice CT
enteroclysis with video capsule endoscopy in 32
patients and concluded, based on their results, that
multislice CT enteroclysis and video capsule endoscopy
have similar diagnostic yields in patients with an
obscure GI bleed.22 Jain et al. found that CT
enteroclysis was better for diagnosing an overt obscure
GI bleed than an occult obscure GI bleed.23
Miscellaneous
When a CT enteroclysis is performed for suspected
small bowel disease, lesions in other organs such as the
appen- dix (Fig. 11) and large bowel (Fig. 12) are
sometimes identified. Bowel contrast sometimes also
opacifies the large bowel, so colonic wall thickening
and strictures can

Fig. 11. Appendicitis. Coronal CT enteroclysis performed in a

48-year-old man for suspected small wall pathology reveals a
thickened appendix (arrow) with adjacent inflammatory changes

Fig. 12. Axial CT enteroclysis image from a 60-year-old man

shows a short-segment smooth stricture (arrow) of the
sigmoid colon

easily be seen. Boudiaf et al. found that the sensitivity

and specificity of multidetector CT enteroclysis for
detecting small bowel pathology were 100% and 95%,
respectively.3
Disadvantages
There are a few disadvantages associated with CT
enteroclysis. Radiation, cost, discomfort to patient,
bowel perforation (rare), aspiration, and inability to
position the tube are common problems. CT enteroclysis
often fails to show fine mucosal changes, such as linear
ulcers and the cobblestone appearance of Crohns
disease. Exposure to ionizing radiation, especially with
repeated CT scans, may lead to an increased incidence
of neoplasms.24 In general, a reduction in the tube

current, voltage, or both and the use of automatic exposure control can lead to dose reductions in CT scans.25
Allen et al. observed that by changing the automatic
exposure control setting strength and reducing the fixed
quality reference mAs, the radiation dose to the patient
was reduced substantially.26
In general, better image quality is associated with a
higher radiation dose; and reducing the radiation is associated with increased image noise.27 Therefore, dose and
image quality should be balanced to achieve the lowest
possible radiation dose with the highest possible image
quality with which an accurate diagnosis can be made.28

Conclusion
Computed tomography enteroclysis is an excellent and
proven diagnostic modality for evaluating small bowel
pathology. One of the main drawbacks is the radiation
exposure involved, especially when repeated scans are
performed in the same patient.
The authors declare no conflicts of interest.

References
1. Cagir B, Sawyer MAJ. Short-bowel syndrome. Available at:
http://e-medicine.medscape.com/article/193391-overview/.
September 2009.
2. Maglinte DD, Hallet R, Rex D. Imaging of small bowel Crohns
disease: can abdominal CT replace barium radiogra- phy? Emerg
Radiol 2001;8:12733.
3. Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R.
Small-bowel diseases: prospective evaluation of multidetec- tor row
helical CT enteroclysis in 107 consecutive patients. Radiology
2004;233:33844.
4. Dean DT, Maglinte MD, Kumaresan Sandrasegaran MD,
Lappas JC, Chiorean M. CT enteroclysis. Radiology 2007;245:
66171.
5. Sailer J, Peloschek P, Schober E, Schima W, Reinisch W,
Vogelsang H, et al. Diagnostic value of CT enteroclysis com- pared
with conventional enteroclysis in patients with Crohns disease.
AJR Am J Roentgenol 2005;185:157581.
6. Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fiddler
JL,
Barlow JM, et al. Crohn disease: mural attenuation and thickness at contrast-enhanced CT enterography: correlation with
endoscopic and histologic findings of inflammation. Radiology 2006;238:50516.
7. Nagi B, Sodhi KS, Kochhar R, Bhasin DK, Singh K. Small
bowel tuberculosis. Abdominal Imaging 2004;29:33540.
8. Maglinte DD, Gage S, Harmon B, Kelvin FM, Hage JP, Chua
GT, et al. Obstruction of the small intestine: accuracy and role
of CT in diagnosis. Radiology 1993;186:614.
9. Maglinte DD, Heitkamp DE, Howard TJ, Kelvin FM, Lappas JC.
Current concepts in imaging of small-bowel obstruction. Radiol
Clin North Am 2003;41:26383.
10.Kohli MD, Maglinte DT. CT enteroclysis in incomplete small
bowel obstruction. Abdom Imaging 2009;34:3217.
11. Walsh DW, Bender GN, Timmons H. Comparision of com- puted
tomography: enteroclysis and traditional computed tomography in
the setting of suspected partial small bowel obstruction. Emerg
Radiol 1998;5:2937.

12.Paulson SR, Huprich JE, Fletcher JG, Booya F, Young BM,

Fidler JL, et al. CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with
over 700 cases. Available at: http://radiographics.rsna.org/
content/26/3/641.full.
13.Ciresi DL, Scholten DJ. The continuing clinical dilemma of
primary tumors of the small intestine. Am Surg 1995;
61:698703/.

14.Minardi AJ Jr, Zibari GB, Aultman DF, McMillan

RW, McDonald JC. Small bowel tumors. J Am Coll Surg
1998; 186:6648.
15.North JH, Pack MS. Malignant tumors of small intestine:
a review of 144 cases. Am Surg 2000;66:4651.
16.Kamaoui I, De-Luca V, Ficarelli S, Mennesson N,
Lombard- Bohas C, Pilleu F. Value of CT enteroclysis in
suspected small- bowel carcinoid tumors. AJR Am J
Roentgenol 2010;194: 62933.
17.Romano S, De Lutio E, Rollandi GA, Romano L, Grassi
R, Maglinte DD. Multidetector computed tomography
entero- clysis (MDCT-E) with neutral enteral and IV
contrast enhancement in tumor detection. Eur Radiol
2005;15: 117883.
18.Huprich JE. Multi-phase CT enterography in obscure GI
bleeding. Abdom Imaging 2009;34:3039.
19.Kobayashi
LM,
Borsatto
R,
Coimbra
R.
A
comprehensive review of upper GI bleeding: the role of
modern imaging tech- nology and advanced endoscopy. J
Surg Rad 2011;2:2441.
20.Maglinte DDT. Invited commentary. Radiographics
2006;26: 65760.
21.Korman U, Kantarci F, Selcuk D, Cetinkaya S, Kurugoglu
S, Mihmanli I. Enterocliysis in obscure gastrointestinal
system hemorrhage of small bowel origin. Turk J
Gastroenterol 2003;14:2439.
22.Khalife S, Soyer P, Alatawi A, Vahedi K, Hamzi L, Dray
X, et al. Obscure gastrointestinal bleeding: preliminary
compari- son of 64 section CT enteroclysis with video
capsule endos- copy. Eur Radiol 2011;21:7986.
23.Jain TP, Gulati MS, Makharia GK, Bandhu S, Garg PK.
CT enteroclysis in the diagnosis of obscure gastrointestinal
bleed- ing: initial results. Clin Radiol 2007;62:6607.

24.Brenner DJ, Hall EJ. Computed tomography: an increasing

source of radiation exposure. N Engl J Med 2007;357:
227784.
25.McCollough CH, Primak AN, Braun N, Kofler J, Yu L,
Christner J. Strategies for reducing radiation dose in CT.
Radiol Clin North Am 2009;47:2740.
26.Allen BC, Baker ME, Einstein DM, Remer EM, Herts BR,
Achkar JP, et al. Effect of altering exposure control settings
and quality reference mAs on radiation dose, image quality
and diagnostic efficacy in MDCT enterography of active
inflammatory Crohns disease. AJR Am J Roentgenol
2010;195:89100.
27.Leng S, Yu L, McCollough CH. Radiation dose reduction at
CT enterography: how low can we go while preserving diagnostic accuracy. AJR Am J Roentgenol 2010;195:767.
28.Schmidt S, Lepori D, Meuwly JY, Duvoisin B, Meuli R,
Michetti P, et al. Prospective comparison of MR enteroclysis
with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of sign-by-sign correlation.
Eur Radiol 2003;13:130311.
29.Dave-Verma H, Moore S, Singh A, Martins N, Zawacki J.
Computed tomographic enterography and enteroclysis: pearls
and pitfalls. Curr Probl Diagn Radiol 2008;37:27987.
30.Wold PB, Fletcher JG, Jhonson CD, Sandborn WJ. Assessment of small bowel Crohns disease: noninvasive peroral CT
enterography compared with other imaging methods and
endoscopy: feasibility study. Radiology 2003;229:27581.
31.Mazzeo S, Caramella D, Battolla L, Melai L, Masolino P,
Bertoni M, et al. Crohns disease of the small bowel: spiral
CT evaluation after oral hyperhydration with isotonic
solution. J Comput Assist Tomogr 2001;24:6126.
32.Boriskin HS, Devito BS, Hines JJ, Carmato VJ, Friedman B.
CT enterography vs. capsule endoscopy. Abdom Imaging
2009;34:14955.

33. Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal

G, Lochs H, et al. Small bowel involvement in Crohns disease: a
prospective comparison of wireless capsule endoscopy and
computed tomography enteroclysis. Gut 2005;54:36973.
34.Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T,
Iino S, et al. Total enteroscopy with a nonsurgical steerable
double-balloon method. Gastrointest Endosc 2001;53:21620.

35.Chen LH, Chen WG, Cao HJ, Zhang H, Shan GD, Li I, et

al. Double-balloon enteroscopy for obscure gastrointestinal
bleeding: a single center experience in China. World J Gastroenterol 2010;16:16559.
36. Yamamoto H, Kita H, Sunanda K, Hayashi Y, Sato H,
Yano T, et al. Clinical outcomes of double-balloon
endoscopy for the diagnosis and treatment of smallintestinal diseases. Clin Gastroenterol Hepatol 2004;2:1010
6.