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Small Bowel Follow Through

Last updated April 20, 2018

Approved by: Krish Tangella MD, MBA, FCAP

A Small Bowel Follow Through uses X-rays (fluoroscopy) to produce a real-time image of the first part of the intestines.


Background Information:

What are the other Names for the Procedure?

  • Lower GI Series
  • Small Bowel Fluoroscopy
  • Small Bowel Follow-Through Exam

What is Small Bowel Follow Through radiology procedure? (General Explanation)

  • A Small Bowel Follow Through uses X-rays (fluoroscopy) to produce a real-time image of the first part of the intestines
  • The procedure uses a contrast agent, which is typically barium or iodine-based. The contrast agent lines the surface of the intestines making them visible on X-rays

What part of the Body does the Procedure involve?

A Small Bowel Follow Through radiology procedure focuses on the small intestines (duodenum, jejunum and ileum).

Why is the Small Bowel Follow Through radiology procedure Performed?

A Small Bowel Follow Through radiology procedure is typically performed to identify or diagnose:

  • Small bowel obstructions (SBO)
  • Inflammatory bowel disease
  • Masses or polyps in the small bowel

The procedure is also performed following surgery in the abdomen.

What are the Alternative Choices for the Procedure?

There are currently no alternatives to a Small Bowel Follow Through radiology procedure.

What is the Equipment used? (Description of Equipment)

The equipment used in the Small Bowel Follow Through procedure may include:

  • A continuous X-ray machine (fluoroscopy), which consists of tubes that generate X-rays
  • A monitor that resembles a computer monitor, to display the results to the radiologist in real-time
  • Specialized digital film to capture the image generated from the X-rays

What are the Recent Advances in the Procedure?

There are no recent advances to Small Bowel Follow Through radiology procedure.

What is the Cost of performing the Abdominal X-ray radiology procedure?

The cost of a Small Bowel Follow Through procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Small Bowel Follow Through procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://www.acr.org/~/media/9408BDFC3C234E4287BD8610FAAFE3F1.pdf (accessed on 2/14/2017)

http://www.ddc.musc.edu/public/tests/diagnostic-radiology/small-bowel-follow-through.html (accessed on 2/14/2017)

https://medlineplus.gov/ency/article/003816.htm (accessed on 2/14/2017)

Prior to Small Bowel Follow Through radiology procedure:

How does the Small Bowel Follow Through radiology procedure work?

  • X-rays, produced by a machine, either pass through or are deflected in the body.  If most the X-rays pass through a structure, it will appear black (such as air-filled lungs); if these are deflected, it will appear white (as in bones). Many structures pass some and deflect some X-rays, and hence, appear in shades of grey
  • The use of a contrast agent helps the small bowel appear more like bones on an X-ray scan
  • Using a continuous X-ray machine, the radiologist can follow the path of the contrast agent, as it moves through the small intestines
  • This can help detect any structural abnormality, obstruction, and tumor mass in the small intestine

How is the Small Bowel Follow Through radiology procedure Performed?

The Small Bowel Follow Through procedure is performed in the following manner:

  • The individual is positioned on an examination table, with the X-ray machine positioned suitably to view the abdomen
  • The individual is asked to drink about 2 cups of a liquid containing the contrast agent
  • Once the contrast has reached the small intestines, the radiologist will begin taking images
  • During the procedure, one may be asked to lay on their side, or have a paddle gentle pressed down on the abdomen, to encourage flow of the liquid through the intestines and improve the quality of images received
  • The radiologist keeps taking images, until the entire small intestine has been imaged

Where is the Procedure Performed?

A Small Bowel Follow-Through Exam is performed as an inpatient or outpatient procedure at a hospital, depending on the indication (or cause for performing the procedure).

Who Performs the Procedure?

A Small Bowel Follow Through radiology procedure is performed by a radiologist or a radiology technologist under the supervision of a radiologist.

How long will the Procedure take?

The duration of the Small Bowel Follow Through radiology procedure varies, but commonly takes up to 2 hours, to capture images of the entire small intestine.

Who interprets the Result?

Typically, a radiologist interprets the series of images and informs the physician who will convey the results to the patient.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Small Bowel Follow Through radiology procedure:

  • The physician will give specific instructions; but, in general, one should avoid eating, drinking, or even chewing gum after midnight of the day before the procedure is to take place
  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • Women should notify the physician if they are pregnant or breastfeeding their child; as many such procedures, may not be performed on pregnant women
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
  • It is recommended to notify the physician about any implants or metal objects in the body, such as a pacemaker, nerve simulators, surgical staples, or artificial heart valves, braces, or dyed tattoos, as they may interfere with the imaging, in some cases
  • The patients are given specific instructions depending upon the study being performed

What is the Consent Process before the Procedure?

A physician will request your consent for the Small Bowel Follow Through procedure using an Informed Consent Form.

Consent for the procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Small Bowel Follow Through procedure:

  • It is a non-invasive procedure
  • It is painless

Following are the risks of the Small Bowel Follow Through procedure:

  • The risk, if any, is minimal
  • The examination can be long and time-consuming
  • Due to exposure to radiation during the procedure, there is a minimal risk for developing cancer

What are the Limitations of the Small Bowel Follow Through radiology procedure?

Using the images obtained, small masses or areas of narrowing may be difficult to spot and may be missed.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is a Small Bowel Follow Through procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Small Bowel Follow Through radiology procedure:

What is expected during the Small Bowel Follow Through radiology procedure?

The following may be expected during a Small Bowel Follow Through radiology procedure:

  • No pan is generally felt during the procedure
  • One may feel some discomfort if an abdominal compression paddle is used to help capture the images
  • The contrast agent may taste unpleasant

What kind of Anesthesia is given, during the Procedure?

No anesthesia is administered during a Small Bowel Follow Through radiology procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss during a Small Bowel Follow Through radiology procedure.

What are the possible Risks and Complications during the Small Bowel Follow Through radiology procedure?

  • As with any exposure to X-rays, there is a small risk of developing cancer with repeated exposure
  • There is a risk to the developing fetus from the procedure, and hence, exposure to X-rays should be avoided during pregnancy
  • The contrast agent may cause disruption in bowel habits leading to diarrhea or constipation

What Post-Operative Care is needed at the Healthcare Facility after the Small Bowel Follow Through radiology procedure?

No post-operative care is needed following a Small Bowel Follow Through radiology procedure.

After the Small Bowel Follow Through radiology procedure:

What is to be expected after the Small Bowel Follow Through radiology procedure?

In general, there are no complications following a Small Bowel Follow Through radiology procedure. The bowel habits may be irregular (constipation or diarrhea), but should return to normalcy in 1-2 days.

When do you need to call your Physician?

If there is a severe abdominal pain or fresh red blood in stool is noticed, you should contact your physician.

What Post-Operative Care is needed at Home after the Small Bowel Follow Through radiology procedure?

Care should be taken to drink adequate amount of fluids to avoid constipation following the procedure.

How long does it normally take to fully recover, from the Procedure?

Additional recovery time is not necessary following a Small Bowel Follow Through radiology procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Small Bowel Follow Through radiology procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out during the Procedure?

Since no tissue is removed during the Small Bowel Follow Through radiology procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Small Bowel Follow Through radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Small Bowel Follow Through procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 21, 2017
Last updated: April 20, 2018