Complications Associated with Selective Contrast Enhanced Radiography

Selected contrast-enhanced studies are performed by injecting a contrast agent through the forceps channel of the double-balloon endoscope, with the balloon at the endoscope tip inflated. This allows contrast-enhanced studies in the small intestine, as well as cholangiog-raphy or pancreatography in the presence of cholangiojejunal or pancreatojejunal anastomosis. Patients undergoing pancreatography should be closely followed up because pancreatitis may occur after a routine examination. When a contrast-enhanced study is performed with the endoscope inserted through the anus into the upper jejunum, a contrast agent may regurgitate beyond the ligament of Treitz, and the stimulus may make the patient vomit. Because examining a patient in a supine position risks aspiration, a contrast-enhanced study should be performed only after preparations have been made to institute prompt measures for treating such an eventuality, including the availability of an oral suction device and postural change to a lateral position.

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