Barium enema
A barium enema is a diagnostic procedure that involves the insertion of barium sulfate, a radiopaque contrast medium, into the colon to enhance X-ray imaging. This test is primarily used for screening and diagnosing conditions such as colorectal cancer, colon cancer, stomach cancer, ulcerative colitis, Crohn's disease, and colon polyps. The procedure can be performed as either a single-contrast or double-contrast barium enema, with the latter offering a more detailed view by introducing air after the barium has been administered to expand the colon.
Before the procedure, patients typically follow a clear liquid diet and may use laxatives to ensure their bowels are clear. The procedure is conducted in an outpatient setting without the need for anesthesia and generally lasts between 20 minutes to 45 minutes, depending on the type of enema used. While barium enemas are considered low-risk, potential complications include constipation or, in rare cases, bowel perforation. Following the procedure, patients are advised to hydrate adequately, as barium may affect bowel movements for several days. Although barium enemas have historically been a common diagnostic tool, their usage has declined in favor of more advanced methods like CT scans and colonoscopies.
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Barium enema
ALSO KNOWN AS: Lower gastrointestinal (GI) series, single-contrast barium enema, double-contrast barium enema, air contrast barium enema
DEFINITION: A barium enema involves the insertion of barium sulfate, a radiopaque contrast medium, into the colon, the first section of the large intestine. This procedure is used with X-rays as a diagnostic and screening test for colorectal cancer, colon cancer, stomach cancer, ulcerative colitis, Crohn's disease, and colon polyps, growths that are sometimes a precursor to colon cancer.
Cancers diagnosed: Colon cancer, stomach cancer, colorectal cancer, colon polyps
Why performed: A barium enema with X-rays is used to screen for and help diagnose colon cancer, stomach cancer, colorectal cancer, and colon polyps. The American Cancer Society recommends screening for colon cancer begin at the age of forty-five, earlier for people at higher risk.
Barium sulfate shows up on X-rays and highlights the shape of the colon better than X-rays alone. A single-contrast barium enema uses barium sulfate that is inserted into the colon. A double-contrast barium enema involves inserting barium into the colon, emptying the colon, and then expanding the colon with air. The barium remains on the lining of the colon, and the air expands the folds of the colon to allow a better view.
Patient preparation: Patients consume a clear liquid diet for one to three days before the test. Patients are instructed to consume large amounts of water and to use laxatives and enemas on the day before the test. An enema may be repeated on the day of the test to make sure the bowel is clear of stool and gas. For women, a pregnancy test may be used to ensure that the patient is not pregnant. Patients should tell their doctor if they have a latex allergy.
A barium enema is an outpatient procedure that is performed at a hospital department or an outpatient radiology center. A barium enema does not require anesthesia, and patients are awake. A single-contrast barium enema takes about twenty to thirty minutes, and a double-contrast study takes about forty-five minutes to complete. Patients disrobe and wear an examination gown for the procedure.
Steps of the procedure: Patients lie on an X-ray table. An X-ray is taken before the barium is inserted. Patients lie on their side for the barium insertion process. A well-lubricated plastic tube is gently inserted through the anus and into the rectum. Barium is slowly poured through the tube to fill the colon. The barium is monitored on a barium fluoroscope monitor. A balloon at the end of the enema tube is inflated to keep the barium in the colon. Patients may receive medication to relieve cramping.
X-rays are taken from a variety of angles. Patients are asked to change positions, and the X-ray table may be tilted. Pressure may be applied to the patient’s abdomen to help move the barium through the colon.
At the end of the procedure, the enema tube is gently removed. Patients empty the barium from the colon by using a bedpan or toilet. After the barium is removed, a few final X-rays are taken.
For a double-contrast barium enema, the colon is drained of barium. The colon is then filled with air, and X-rays are taken. When the procedure is complete, the enema tube is removed, and patients empty the colon of barium. A few final X-rays are taken.
After the procedure: Patients should drink plenty of fluids to help remove the barium from their bodies. Bowel movements will contain barium for a few days following the tests. The barium may make bowel movements appear pink, gray, or white in color.
Risks: A barium enema is a low-risk procedure. Occasionally, the barium may harden, resulting in constipation. Drinking extra fluids and using a laxative may relieve constipation. In rare cases, the bowel may become inflamed or perforated. Patients should contact their doctor if they experience bleeding, severe pain, fever, or no bowel movements within two or three days of the procedure.
Results: The X-ray images are read by a radiologist. The ordering doctor may review the images as well. A healthy colon and rectum are free of abnormal growths or polyps. Any abnormalities, such as cancer or precancerous tissues, are visible on the images. Abnormal results are followed with colonoscopy.
As the twenty-first century progressed and cancer diagnostic tools evolved, the medical community used barium enemas less. Instead, Computed Tomography (CT) scans and colonoscopies replaced barium enemas as more accurate diagnostic tools in diagnosing colon cancer. CT colonography (CTC) is a minimally invasive procedure that is more sensitive than barium enemas, more cost-effective, and a more accurate diagnostic tool.
Bibliography
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