| BackgroundWith the advancement of imaging technology,computed tomographic enterography(CTE)is becoming first-line modality for the examination of small bowel disease,particularly inflammatory bowel disease(IBD).The quality of a CTE examination mainly depends on adequate intestinal distention and wall visibility,which optimizes the resolution of the bowel wall and lumen.The oral contrast agents used in the examinations is considered a key point in achieving a satisfactory outcome.Since no serious adverse reactions have been reported,low-concentration mannitol solution is presumed to be safe and widely used in CTE in recent years.However,whether the use of isotonic mannitol as oral contrast agent in CTE will bring more side effects remains to be confirmed.Since there were few relevant prospective studies available,whether the quality of CTE imaging using polyethylene glycol(PEG)as oral contrast agent is not inferior to mannitol remains to be verified,despite the advantages of safety.AimTo prospectively compare the performance,tolerability and acceptability of mannitol and PEG in patients undergoing CTE.MethodsFrom October 2017 to August 2018,patients aged 18-75 years who were referred for CTE were randomized to receive either mannitol or PEG as oral contrast agent.Each quadrant of the coronal reconstructed image was assessed for maximum distention,proportion of bowel loops distended,presence of inhomogeneous content and bowel wall visibility.Overall subjective quality assessment and whether the contrast agent reached the caecum were recorded.Patient tolerability and acceptability were also evaluated.ResultsEighty-five eligible inpatients were assessed for inclusion and a total of 70 patients were randomized into either the mannitol group or the PEG group.There were no significant differences in the age(P = 0.951),sex distribution(P = 0.810),or body mass index(BMI)(P = 0.514)between the two groups.In per-protocol analysis,no significant difference was found in imaging quality with respect to bowel distention(2.8±1.0 vs.2.9±0.9,PMP=0.295),maximum diameters(21.8±1.5 vs.21.9±1.4,PMP=0.695),wall visibility(3.4±0.9 vs.3.4±0.8,PMP=0.787)and intestinal homogeneousness(96.8%vs.98.3%,PMP=0.457).The mean nausea score of the mannitol group was significantly lower(0.0±0.3 vs.1.8±2.1,PMP<0.001).No difference was found in the scores of vomiting,diarrhea,abdominal pain and abdominal distention between the two groups.The contrast sgents reached the cecum in all the patients enrolled.No significant difference was found in the appearance of inhomogeneous substancee between the two groups(96.8%vs.98.3%,P=0.457).)Mannitol was superior to PEG in taste(9.0±1.2 vs.6.1±2.8,PMP<0.001),patient willingness to reuse the drug(8.8±1.2 vs.7.9±2.0,PMP=0.049),satisfaction(8,8±1.1 vs.8.2±1.3,PMP=0.035)and ease of completion(8.5±1.2 vs.7,7±1.6,PMP=0.018).ConclusionBoth isotonic mannitol solution and PEG electrolyte solution provided good bowel distention and visualization of bowel wall.However,mannitol was significantly superior to PEG in nausea and patient acceptability.SignificanceThis study demonstrateed that the use of isotonic mannitol solution as a neutral oral contrast agent in CTE does not increase the risk of additional adverse reactions;PEG electrolyte solution as a safe option can also provide good bowel distention.This study provides an evidence-based basis for the application of these two neutral contrast agents in CTE,which is conducive to individualized clinical treatment. |
PDF Full Text Request