Influence of oral contrast type and volume on patient experience and quality of luminal distension at MR Enterography in Crohn's disease: an observational study of patients recruited to the METRIC trial

METRIC study investigators

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Abstract

OBJECTIVES: To compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE.

METHODS: This study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn's. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG). Additionally, 130 patients (77 F, mean age 34) completed a questionnaire rating tolerability of various symptoms immediately and 2 days after MRE (85 [65%] receiving mannitol 45 [35%] receiving PEG). Distension was compared between agents and between those ingesting ≤ 1 L or > 1 L of mannitol using the test of proportions. Tolerability grades were collapsed into "very tolerable," "moderately tolerable," and "not tolerable."

RESULTS: Per patient distension quality was similar between agents ("excellent" or "good" in 54% [37/68] versus 46% [17/37]) with mannitol and PEG respectively. Jejunal distension was significantly better with mannitol compared to PEG (40% [27/68] versus 14% [5/37] rated as excellent or good respectively). There was no significant difference according to the volume of mannitol ingested. Symptom tolerability was comparable between agents, although fullness following MRE was graded as "very tolerable" in 27% (12/45) of patients ingesting PEG, verses 44% (37/84) ingesting mannitol, difference 17% (95% CI 0.6 to 34%).

CONCLUSION: Mannitol-based solutions and PEG generally achieve comparable distension quality and side effect profiles, although jejunal distension is better quality with mannitol. Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.

KEY POINTS: • Mannitol-based and PEG-based oral preparation agents generally achieve comparable distension quality for MRE with the exception of the jejunum which is better distended with mannitol. • Mannitol-based and PEG-based oral preparation agents used for MRE have similar side effect profiles. • Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.

Original languageEnglish
Pages (from-to)5075-5085
Number of pages11
JournalEuropean Radiology
Volume32
Issue number8
Early online date3 Mar 2022
DOIs
Publication statusPublished - Aug 2022

Bibliographical note

Funding Information:
This work was supported by the National Institute of Health Research health technology assessment NIHR HTA programme (project number 10/68/01) published in full in Health Technology Assessment, 2019 Aug;23(42):1–162. https://doi.org/10.3310/hta23420 . PubMed PMID: 31432777. The project is supported by researchers at the National Institute for Health Research University College London Hospitals Biomedical Research Centre, and by and NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, NIHR, NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), HTA programme, or the Department of Health.

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Crohn’s disease
  • Diagnostic imaging
  • Magnetic resonance imaging

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