Barium Enema

Unfortunately Barium Enema is also uncomfortable for the patient. Many patients who have had both investigations say that the Barium was more uncomfortable than endoscopy. This is most likely due to the effects of the drugs which are given at the time of endoscopy, whereas the patient needs to be kept awake to co-operate with the person performing the enema.

The 'double contrast' barium enema is superior to 'single contrast' enema. The two contrast agents are the barium and gas. The patient has a bowel preparation. They have a tube inserted into the anal canal and barium is permitted to flow into the recutm. The patient lies on a table and the patient and table are moved around to get the barium to pass up the bowel. Then gas is inserted to give the double contrast effect.

It is unfortunate that the patient has to be able to co-operate with the operator for Barium enema as the patients who need it most are least able to co-operate.

The main advantages of the Barium Enema are;

• No need for concious sedation
• Operator has a more accurate idea of how far up the bowel the barium had progressed
• Greater chance of viewing the caecum

The main disadvantages of Barium Enema are;

• Cannot get tissue for diagnosis
• Cannot remove polyps
• More patient co-operation required
• As with colonoscopy bowel preparation is required
• If the operator sees something abnormal he usually requests that the patient undergo further endoscopic investigation of the suspicious area, even though the reason that the patient has been referred for the barium enema is that the patient already has had the endoscopic procedure and the Barium was requested because it was not possible to complete the endoscopic examination

Figure 5: Gastrograffin saves the day: Gastrograffin enema done day 4 post anterior resection. A large radiological leak is evident. The patient had not had a covering loop ileostomy. The patient went back to theatre, the anastamosis was taken down and an end stoma was formed in the left iliac fossa. She then had an uneventful further recovery.

One great advantage of enemas is in the acute situation where the clinician wants to differentiate mechanical from pseudo-obstruction. A gastrograffin enema will safely differentiate these two possbilities whereas an endoscopic examination would be dangerous. An analagous situation occurs following anterior resection where the clinician would like to ensure that there is no anastamotic leak before this becomes clinically apparant.

In summary, Barium enema is a useful investigation and is complementry to endoscopic examination.