Double contrast barium enema

The entire large bowel should be evaluated by colonoscopy or flexible sigmoidoscopy with double-contrast barium enema. 

Reactions to other constituents of barium sulfate enemas have been recognized (SEDA-18, 441) and could be as common as one in 1000. They vary from urticarial rashes to severe anaphylactic reactions, and can be particularly severe in patients with asthma (13). Hypersensitivity to the latex balloon catheter used in double contrast barium enemas appears to be a common mechanism (14), but hypersensitivity to glucagon, to the preservative methylparabens, or to other additives seems to be responsible in some cases. Insofar as the latex balloon is concerned, thorough washing will remove the allergen responsible for the reaction (15). 

Peterson N, Rohrmann CA Jr, Lennard ES. Diagnosis and treatment of retroperitoneal perforation complicating the double-contrast barium-enema examination. Radiology 1982 144(2) 249-52. 

Macleod AJ, Duncan KA, Pearson RH, Bleakney RR. A comparison of Fleet Phospho-soda with Picolax in the preparation of the colon for double contrast barium enema. Clin Radiol 1998 53(8) 612-14. 

Double contrast barium enema M and F 50 and over Every 5 years... 

If colonoscopy is not available or feasible, DCBE alone or together with flexible sigmoidoscopy are acceptable alternatives. DCBE, double-contrast barium enema FOBT, fecal occult blood testing. 

Lymphoid hyperplasia affecting the colon in infants and children is well recognised and best seen on a double contrast barium enema. The classical finding is a mucosa studded with innumerable 1- to 3-mm small uniform nodules. Some of these lesions may show an umbilicated center but this is not always seen. Whilst it is normal to find some lymphoid follicles in the pediatric gut they are usually sparser and more diffuse. 

Whilst the barium follow through is the main contrast examination for assessing the small bowel in IBD (Fig. 6.16b) it may still provide information on the colon if delayed views are obtained however, the barium enema is mainly used in the colon. A double-contrast technique is necessary for mucosal delineation although for patients with advanced disease a single contrast study may be adequate. Some centers have a preference for performing small bowel enteroclysis. 

CTC in symptomatic patients is to be considered when colonoscopy can not be completed or carried out this may occur due to mechanical hindrance such as pelvic adhesions, in cases of high risk of perforation as in complicated diverticular disease, when there is an obstruction due to cancer or extracolonic diseases, when the cecum cannot be reached in extreme dolicocolon conditions, or in patients with poor tolerance to colonoscopy in whom heavy sedation may be dangerous (elderly patients or patients with severe co-morbidity). Such indications are similar to those of double contrast barium enema (DCBE) however, CTC has been shown to be both more accurate and better tolerated than DCBE, and should be used preferentially whenever available (Rocket et al. 2005 Taylor et al. 2005 Taylor et al. 2006). Furthermore, in cases of obstructing colonic cancer, CTC is a valuable tool, as it can be conveniently performed at the time of a contrast-enhanced abdominal CT scan for staging purposes to detect synchronous colorectal carcinomas, metas-... 

Goei R, Nix M, Kessels AH et al (1995) Use of antispasmodic drugs in double contrast barium enema examination glucagon or buscopan Clin Radiol 50 553-557 Gollub MJ, Jhaveri S, Schwartz E et al (2005) CT colonography features of sigmoid diverticular disease. Clin Imaging 29 200-206... 

CT colonography and double-contrast barium enema. Clin Radiol 60 207-214... 

Taylor SA, Halligan S, Slater A et al (2006b) Comparison of radiologists confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema. Br J... 

Vora P, Chapman A (2004) Complications from radiographer-performed double contrast barium enemas. Clin... 

Winawer SJ, Stewart ET, Zauber AG et al (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 15 342 1766-1772 Winawer SJ, Fletcher RH, Rex D et al (2003) Colorectal screening and surveillance clinical guidelines rationale-update based on new evidence Gastroenterology 124 544-560... 

Evidence-based comparisons with existing approved screening tests (FOBT, flexible sigmoidoscopy, double contrast barium enema, colonoscopy) will show that none is perfect and that CTC has a sufficient number of benefits and unique attractions to make it a legitimate addition. 

Several studies have shown that patients acceptance of CTC is greater than conventional colonoscopy or double contrast barium enema (Taylor et al. 2003). Development of minimal bowel prep or prep-less CTC through fecal tagging and electronic cleansing appears to be within reach, thus making a truly prep-less colorectal screening test an attractive possibility (Lefere et al. 2002). 

Although double contrast barium enema evaluates the entire colon, many proponents of the new technology believe that CTC should be the study of choice for patients whom are unable to undergo con-... 

Double contrast barium enema remains in the algorithm for work-up of colorectal cancer in evaluation of the proximal bowel in cases of an obstructing mass. This examination is not preferred, as the proximal colon often does not drain all of the barium by the time of surgery. Patients are also at increased risk for post-operative morbidity if a reactive peritonitis develops secondary to barium contamination intr a- operatively. 

The incidence of synchronous neoplasia in the colon has been described at a rate of 1.5-9%. Adenomas harboring in the colon in patients with colon cancer have been reported at an incidence of 27-55%. Fenlon et al. compared CTC to pre-operative double contrast barium enema in the evaluation of patients with an obstructing carcinoma (Fenlon et al. 1999a). CTC identified all ofthe cancers including 2 synchronous cancers proximal to the obstructing mass that were missed by barium enema (Fenlon et al. 1999a). In addition, CTC demonstrated 16 of 18 polyps in the proximal colon. 

The role of CT colonography has been evaluated specifically in this patient population. Incomplete colonoscopies secondary to post-operative strictures and rigid mesentery have been reported. In 2002, Gollub et al. reported a conventional colonoscopy failure rate of 4%-29% in post-operative or post-radiotherapy patients (Gollub et al. 2002). These patients would undergo a double contrast barium enema for complete evaluation of the colon. As discussed, CTC sensitivity for polyp detection is greater than DCBE and thus makes it a superior surveillance tool in this subset of patients. 

CTC has been shown to be superior to double contrast barium enema following incomplete conventional colonoscopy and, in fact, failed colonoscopy was the first established indication for CTC. An incomplete colonoscopy is defined as failure to intubate up to the cecum. The reported rate of failed colonoscopy ranges from 8% to as high as 35%. Patients with a history of an incomplete colonoscopy have a significantly increased risk of failing a second attempt. A multitude of reasons contribute to a failed conventional colonoscopy poor bowel... 

In this patient population with history of colitis and possible prior segmental colonic resections, fistulas and strictures often develop at the anastomosis and make passage of the colonoscopy device impossible. Scarring of the mesentery may also cause rigidity and may lead to failed colonoscopies. Historically, patients would then go on to double contrast barium enema for complete evaluation of the colon. 

Johnson C, MacCarty R, Welch T et al. (2004) Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for the screen detection of colorectal polyps. Clin Gastroenterol Hepatol 2 314-321 Kusama T, Ota K (2002) Radiological protection for diagnostic examination of pregnant women. Congenital Anomalies 42 10-14... 

---