SBE was considered the best exam for SB disease, however children poorly tolerate the required insertion of a naso-jejunal most tube. SBFT has long been considered as the most common, non-invasive, inexpensive and easily accessible radiological method[14], but, currently, it has only a secondary role in small bowel imaging. US and MR enterography are methods of choice for imaging SB diseases in pediatric populations. Early mucosal changes, such as aphthous ulceration, can be detected by SBFT. This technique can also assess bowel motility that help to differentiate strictures from mural thickening and allows a functional evaluation of the pathological segment studying the SB transit time[14-16].

Although SBE and SBFT can effectively depict the presence of mucosal abnormalities effectively, including fissures, cobblestone mucosa, pseudo-polyps, and skip lesions, they are imprecise for the diagnosis of transmural and extramural disease[14,20,21], except in the overt forms (Figure (Figure11). Figure 1 Barium studies in patients with Crohn��s disease. Double-contrast barium enema examination (A and B) demonstrate longitudinal (arrows) and perpendicular (arrowheads) ulcerations in the terminal ileum. Small-bowel follow-through (C) demonstrates … A retrospective analysis of 164 children revealed a diagnostic sensitivity of only 45% for SB radiography compared with ileo-colonoscopy[22]. Moreover, SBFT is not accurate for the detection of active CD in the SB[20-23]. In fact, it can directly examine the mucosa demonstrating early active mucosal disease such as aphthous and linear ulcers, but it does not allow to evaluate the small bowel wall and the mesentery, except with indirect signs.

Moreover, superimposed bowel loops or non-palpable bowel loops deep in the pelvis can hide active disease or its complications[20]. Concerns regarding the risks of radiation Carfilzomib exposure in the pediatric population has increased with the spread use of these imaging studies. Children especially are at risk because they are inherently more radiosensitive and because they have more remaining years of life during which a radiation-induced cancer could develop[24]. A major disadvantage of barium studies, especially in children, is the radiation exposure, particularly if fluoroscopy time is not kept to a minimum[13]. Gaca et al[13] studied a total of 176 children with CD who underwent averaging 1.2 SBFTs. On average SBFT took 5.1 min with 3.3 abdominal radiographs. The effective doses (mSv) for a 5-min fluoroscopy were 0.15 for the central abdomen, 0.35 for the right lower quadrant, and 0.56 for the pelvis, yielding an average effective dose for SBFT (5-min fluoroscopy, 3.3 abdominal radiographs) of 1.8-2.2 mSv.