Does a normal small-bowel enteroclysis exclude small-bowel disease? A long-term follow-up of consecutive normal studies.

The purpose of our study was to determine if a normal small-bowel enteroclysis excludes small-bowel disease in adult patients, using long-term follow-up as the major reference standard. We reviewed 193 consecutive small-bowel enteroclysis (SBE) studies completed during a period from January 1987 to February 1989, of which 83 were judged to be normal at the time of the study. Eight of these latter patients were excluded due to inadequate follow-up. The indications included detection of gastrointestinal bleeding, small-bowel obstruction, Crohn's disease, nonspecific abdominal pain, chronic diarrhea, and a miscellaneous group. Each patient was followed for at least 3 years by chart review or until a definite diagnosis was established. Six of the 75 patients whose SBE was originally interpreted as normal were eventually judged to have small-bowel disease. The remaining 69 patients were judged to be free of small-bowel disease by autopsy, surgical laparotomy, endoscopic observation or biopsy, or long-term follow-up for at least 3 years. Therefore, a normal SBE correctly excluded small-bowel disease in 69 of our 75 patients (true negatives) and failed to diagnose disease in six patients (false negatives), for a specificity of .92 +/- .03 (SE). In this experience, SBE was sufficiently specific in most patients to exclude small-bowel disease.