Oral contrast agents: Kids do have preferences
Drinking an oral contrast agent before a magnetic resonance enterography (MRE) exam is not pleasant, but it can be made more palatable if patients, especially children, can choose their agent.
Radiologists at Massachusetts General Hospital in Boston hypothesized that palatability would significantly differ among agents, and that the availability of multiple contrast agents might help some pediatric patients ingest a higher total oral contrast volume than if offered only a single agent. Their prospective, randomized study of 75 children under age 19 published online March 9, 2019, in Pediatric Radiology confirmed both hypotheses.
The children, who had suspected or known Crohn’s disease, underwent MRE exams at MGH between January 2017 and March 2018. They were randomized to receive either a sugar alcohol oral contrast preparation (Breeza, Beekley), polyethylene glycol (MiraLAX, Bayer), or low-concentration barium sulfate (VoLumen, Bracco). Children aged 10 years or younger and weighing less than 50 kg were asked to consume 24 fluid ounces; older and heavier children received 36 fluid ounces.
Each patient was asked to rate the taste from 1-5 (terrible to excellent) and to state if they would drink the same contrast agent if they needed another MRE. They also were asked to rate their general feeling of well-being after consuming the agent.
Twenty-three patients received Breeze, 24 MiraLax, and 28 VoLumen. Forty patients drank the entire prescribed volume, which was highest for MiraLAX (70%) than for VoLumen (30%). Nine patients who had difficulty drinking the preparation they were assigned switched to another, after which 6 did consume the prescribed volume.
Lead author Ravi V. Gottumukkala, MD, a fourth-year radiology resident, and colleagues reported that MiraLAX was most preferred, followed by Breeza, then VoLumen. Eighty-two percent of patients said they would be willing to consume MiraLAX again compared to 61% for Breeza and 46% for VoLumen. Levels of well-being felt by the children were similar regardless of the type of contrast preparation they ingested.
Two radiologists reviewed the exams, rating them for global features and features specific to individual small-bowel segments. They found no significant difference among agents in either quantitative or qualitative imaging metrics of small bowel distension. All three agents were equally effective at distending the small bowel on MRE in these pediatric patients.
“Compliance with the large oral contrast volume required for MRE and computed tomographic enterography is often challenging,” wrote the authors.“ When an initial agent is poorly tolerated, offering multiple choices of alternative agents could enhance compliance compared to offering a single alternative agent.”
Reference
- Gottumukkala RV, LaPointe A, Sargent D, et al. Comparison of three oral contrast preparations for magnetic resonance enterography in pediatric patients with known or suspected Crohn disease: a prospective randomized trial. Pediatr Radiol. Published online March 9, 2019. doi: 10.1007/s00247-019-04378-5.