Radiographic Examination of the Duodenum:Focused on Hypotonic Duodenography Yusuke Saitoh 1 , Masaki Taruishi 1 , Yu Kobayashi 1 , Junpei Ikeda 1 , Ken Terasawa 1 , Ryuji Sugiyama 1 , Ryuji Sukegawa 1 , Yuhei Inaba 1 , Motoya Tominaga 1 , Kenichiro Ozawa 1 , Mikihiro Fujiya 2 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan 2Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan Keyword: 低緊張性十二指腸造影 , 十二指腸乳頭 , 有管法 , 充盈像 , 二重造影像 pp.1243-1252
Published Date 2019/8/25
DOI https://doi.org/10.11477/mf.1403201819
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 Radiographic examination of the duodenum is performed to delineate intraduodenal lesions and to evaluate the extent of the disease and involvement of adjacent organs. Hypotonic duodenography is a radiographic procedure that obtains double-contrast images under hypotonic conditions by administering an antispasmodic drug. This technique has two types:tube-assisted and tubeless. For detailed examinations, the tube-assisted method is suitable because minute findings can be obtained by adjusting the amount of barium and air. Hypotonic duodenography is performed by intubation of the balloon tube into the duodenum, followed by inflation of the balloon to fix the position of the tube in the duodenal bulb. An antispasmodic drug is then administered to the patient, followed by slow injection of barium through the tube to obtain barium-filled images. Next, in the prone or supine 1st oblique position, 300-400mL of air is injected until the duodenum lumen is adequately extended and double-contrast images are obtained. The purpose of the double-contrast study should be to visualize the frontal and lateral images of the duodenal papilla. In addition, double-contrast images can be obtained in the following positions:prone, prone 1st and 2nd oblique, supine, and supine 1st and 2nd oblique. Interpretation of the results depends on:(1)duodenal shape and changes of the duodenal border,(2)abnormality of the Kerckring folds and location and shape of the duodenal papilla,(3)abnormality of the duodenal mucosa(conversing mucosal folds, polypoid lesions, and erosions or ulcers), and(4)diagnosis determined after evaluating the multiple images in various positions and amounts of air.

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