Small bowel follow through

Small bowel follow through (SBFT) is a fluoroscopic technique designed to obtain high resolution images of the small bowel. The function of the small bowel can also be evaluated.

Indications

The SBFT can be used for evaluation of small bowel abnormalities, including:

  • strictures
  • obstruction
  • diverticula
  • masses
  • extraluminal tethering
  • abnormal motility

Limitations of the SBFT include:

  • intermittent passage of contrast through the pylorus breaks up the contrast column
  • less severe strictures and small masses may be difficult to see

The SBFT is inferior to enteroclysis for evaluation of small bowel pathology, but enteroclysis has drawbacks that prevent it from being more widely used.

Procedure

A small bowel follow through is a single contrast study (oral contrast, either barium or water-soluble contrast). It is often performed after an upper GI fluoroscopic study, as the contrast column moves from the stomach and duodenum to the small bowel. A small bowel follow through may also be performed by itself, without the upper GI investigation of the esophagus, stomach, and proximal duodenum. but this is less common.

Equipment
  • barium specially prepared for the small bowel (e.g. low density 30-50% weight/volume)
    • if concerned about a small bowel leak, water-soluble contrast should be used
    • high-density barium used for double contrast upper GI studies is suboptimal for evaluation of distal small bowel loops
    • fomulations including sorbitol are suboptimal for evaluation of small bowel detail 3
  • palpation padde with leaded glove
Technique

There are multiple different techniques that have evolved for performing a small bowel follow through. The following technique is one conventional approach.

  1. Patient starts fasting at midnight. Study is scheduled for the next morning.
  2. The patient drinks 1-2 cups of the enteric contrast (barium or water-soluble), and a single contrast upper GI is performed.
  3. After this, the patient drinks an additional 1-2 cups and waits outside the fluoroscopy suite.
  4. After 15-30 minutes, a spot radiograph of the abdomen is obtained and the patient is re-evaluated with fluoroscopy.
  5. A spot radiograph with fluoroscopic re-evaluation is continued every 15-45 minutes until the enteric contrast reaches the terminal ileum and enters the ascending colon.
    1. The patient is usually positioned during interval fluoroscopy for better evaluation of small bowel loops and paddle palpation is used to spread out bowel loops.
    2. Normal small bowel transit ranges between 30-120 minutes.
Variations

If desired, the peroral pneumocolon technique may be attempted at the end of a small bowel follow through. The colon is insufflated with gas to try to reflux gas into the terminal ileum and allow double contrast images (gas and enteric contrast) of the terminal ileum.

Some practitioners use metoclopramide (Reglan) to increase small bowel motility and shorten the exam. The compromise is that evaluation of bowel distention and native bowel motility is decreased.

Some practitioners use a modified bowel prep to try to clear the right colon.

Barium studies
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Article information

rID: 36905
Section: Approach
Synonyms or Alternate Spellings:
  • Small bowel follow through (SBFT)
  • SBFT

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Cases and figures

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    Case 1: scleroderma on SBFT
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    Case 1: scleroderma on SBFT, coned-in image
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