Crohn’s disease (CD) is a chronic inflammatory disorder that may invade the gastrointestinal tract from mouth to anus; it is characterized by periods of flare-up with active symptomatic disease and periods of remission [
1]. Inflammation of CD is transmural and therefore may be complicated by fistula, abscess formation, perforations, and fibrotic strictures. The frequent and periodic evaluations of inflammation of CD are vital in planning a proper therapy, monitoring the drug effects, and detecting recurrence [
2].
Magnetic resonance enterography (MRE), a target examination of the gastrointestinal tract, has been shown to be highly effective in the diagnosis and management of patients with CD [
3]. A recent systematic review indicated that the sensitivity and specificity of MRE for the diagnosis of suspected CD were 78% and 85%, respectively [
4]. For the extension of CD lesions, the sensitivity and specificity of MRE for small bowel lesions were 74% and 91%, respectively [
4]. On a per-patient basis, MRE had an overall sensitivity of 91% and a specificity of 71% for active disease [
5]. Compared with other imaging examinations, MRE has many advantages such as no ionizing radiation, offering better soft tissue contrast resolution, superior evaluation of perianal disease, better distinction between acute and chronic disease, distinguishing from prominent muscle hypertrophy to prominent fibrosis [
6], and superior detection of fistulas and strictures in CD with functional techniques such as diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) [
7].
MRE examination requires adequate bowel distention as collapsed loops may hide lesions or mimic disease by suggesting a thickened bowel wall [
8]. Bowel distention can be achieved by two methods, administering contrast solution after mid-gut tubing and administering contrast solution orally. Mid-gut tubing, such as nasojejunal tubing and nasoduodenal tubing, provides better bowel distention [
9,
10]. Traditionally, mid-gut tubing can be operated under fluoroscopic or electromagnetic guidance or with endoscopic assistance. The procedure of conventional tubing is considered to be unpleasant and time-consuming, and/or with radiation in patients especially younger ones [
10]. The transendoscopic enteral tubing (TET) in mid-gut is a novel and quick technique of enteral tubing under the endoscopy [
11]. The mean procedure time (from the beginning of inserting the tube into the esophagus to the tube being fixed on the pylorus wall by one titanium clip) for tubing was 4.2 ± 1.9 min (range, 1.53–11.25 min) [
11]. The mid-gut tube can be used for repeat fecal microbiota transplantations (FMTs) and enteral nutrition support in CD [
12‐
14]. Furthermore, based on our practice, we found that the mid-gut tube might be used as a perfect delivering for the large volume laxative and contrast solution for bowel preparation for MRE. Bowel preparation for MRE includes bowel cleaning and bowel distention. Administering solution through the mid-gut tube may lead to better bowel distention and alleviates adverse symptoms from drinking a large volume of fluid laxative and contrast solution. In clinical practice, some patients may not tolerate a large oral fluid load, leading to adverse symptoms such as nausea, vomiting, bloating, abdominal pain, and diarrhea [
15‐
17]. In addition, despite large oral volumes, distention of the distal small bowel, where diseases are most likely to occur, can still be poor [
5]. This not only aggravates the mental pressure of patients, but also affects the accuracy of the judgment from the physicians for the disease. Therefore, our study aims to evaluate the efficacy and compliance of bowel preparation through mid-gut tubing for MRE in patients with CD.