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A lower GI series, also known as a barium enema, barium enema procedure, barium enema X-ray or double-contrast barium enema, is an X-ray test in which a white liquid, called barium, is infused through a catheter (tube) inserted through the anus and into the rectum until it fills the large bowel (colon). X-ray films of the colon then are taken so that the outline of the colon can be seen. The barium enema and double contrast barium enema are used to define normal and abnormal anatomy of the colon and rectum. Colon and rectal abnormalities that can be detected include diverticulosis, diverticulitis, polyps, colonic abscesses, abnormal colon movement, dilation of the colon, Hirschsprung disease in infants, and cancers.
Indications for barium enema
Suspected small bowel disease (e.g. Crohn's disease); barium small bowel enema (gradually being replaced by CT in adults and ultrasound in children and young women).
Malabsorption; barium small bowel enema may be indicated, e.g. if diagnosis of coeliac disease uncertain and biopsy is normal or equivocal, and for complications of coeliac disease such as lymphoma. Barium small bowel enema is more accurate than a barium small bowel meal.
Change of bowel habit to looser stools with or without rectal bleeding persistent for 6 weeks; suspected or possible colorectal neoplasia (colonoscopy is first line investigation but barium enema is an alternative).
Chronic or recurrent lower gastrointestinal blood loss; only if endoscopy (initial investigation of choice) is not possible.
Long term follow up of inflammatory bowel disease of colon; barium enema has a limited role after complex surgery and in the evaluation of fistulae. Colonoscopy is more reliable in identifying complications, e.g. dysplasia, stricture and carcinoma.
Acute large bowel obstruction; water-soluble studies with contrast enema can confirm diagnosis and level of obstruction, and may indicate the likely cause.
The equipment used for most lower GI examinations consists of a large, flat table. A moveable apparatus extends over a portion of the table and sends real-time images to a television monitor. Multiple static images are obtained by the radiologist and technologist for later review. The table can move and tilt and contains a drawer with a fluorescent plate that captures the image and sends it to a nearby television monitor for viewing.
Barium Enema Examination
For the barium enema examination to be successful, your intestines must be completely empty. Typically, you will be asked to follow a restricted diet for two days prior to the examination. This may include a soft diet or a liquid diet. You also will be required to take a laxative the evening before the examination, and you also may be asked not to eat or drink anything after midnight the night before the exam. Your doctor will give you specific instructions, which you should follow closely. Any residue in your lower digestive tract will show up on the x-rays and could be mistaken for an abnormality in the colon or rectum.
Before your examination, a radiographer will explain the procedure to you and answer any questions you might have. A radiographer, also known as a radiologic technologist , is a skilled medical professional who has received specialized education in the areas of anatomy, radiation protection, patient care, radiation exposure, radiographic positioning and
radiographic procedures. As part of his or her duties, the radiographer will determine the amount of radiation necessary to produce a diagnostically useful image.
Prior to performing your barium enema examination, the radiographer will give you a hospital gown to wear. This gown has no metal snaps on it, because metal can interfere with the accuracy of the image. It is important that everything underneath this gown be removed, including jewelry and underwear.
If you are a woman of childbearing age, the radiographer will ask if there is any possibility you are pregnant. Because this examination exposes the pelvic area to radiation, it is important that you tell the radiographer the date of your last menstrual period and whether there is a chance that you may be pregnant.
During the Examination
Inside the x-ray room, you will be asked to lie down on a tilting table attached to a fluoroscope, which is a x-ray unit combined with a television screen. The radiographer will take an x-ray of your abdomen to make sure that your intestines are clean. Next, the radiographer will insert a lubricated enema tip into your rectum. A radiologist will come into the room and begin the examination. Liquid barium will begin to flow through the enema tip, a little at a time. Barium is a special compound that allows radiographic visualization of the gastrointestinal tract. It coats the walls of your lower digestive tract, casting shadows that can be recorded on x-ray film. The radiologist will watch the television screen to observe the flow of barium, and films will be taken throughout the process.
As the barium is being delivered, the radiologist will ask you to turn from side to side. This allows the barium to coat the walls of your colon. If you feel uncomfortable or are not able to turn over, you should tell the radiographer or radiologist. Their goal is to make you as comfortable as possible and at the same time perform a successful examination.
After the barium has been administered, the radiographer will take a series of x-rays of your large intestine. You will be asked to hold your breath and remain still during the exposure. It also is important that you try to hold in the enema. Once the films are complete, the radiographer will show you to the toilet facilities so you can expel the barium. After you have expelled the barium, the radiographer may take another x-ray to assess whether any barium remains.
In some cases, the radiologist may introduce air along with the barium solution. This examination is called a high-density, double-contrast or air-contrast barium enema examination. The air will be inserted through the same enema tip as the barium. During the procedure, you may experience cramping or a sensation of being bloated. It is important that you try not to expel the air or the barium. Because barium used in this procedure is thick, it clings to the walls of the colon rather than filling the colon itself. The air is used to expand the walls of the colon and allow the radiographer and radiologist to get more detailed images.
Once the examination is complete, the radiographer will process your x-ray films and determine whether they are technically acceptable. The films then will be given to a radiologist to interpret. Radiologists are physicians who specialize in the diagnostic interpretation of medical images.
After your radiographs have been reviewed by a radiologist, your personal physician will receive a report of the findings. Your physician then will advise you of the results and discuss what further procedures, if any, are needed.
The barium will make your stools white for a few days. This is normal. If you experience constipation following the examination, tell your doctor. He or she may advise you to take a laxative. You also should increase your water consumption in the days following the examination.
The radiation that you are exposed to during this examination, like the radiation produced during any other x-ray procedure, passes through you immediately. You are not "radioactive," and it is not necessary to take any special precautions following your examination.
What are the risks of a barium enema?
Distention of the colon is uncomfortable, but only a few patients find it very painful. Any X-ray test procedure involves some risk of radiation exposure. The radiation exposure is minimized by standard techniques which have been developed and approved by national and international radiology committees and councils. All radiology technologists are certified by national certifying boards.
Women who are or may be pregnant should notify the doctor requesting the procedure and the radiology staff, as there is a potential risk of harm to the fetus with any radiation exposure. Complications of barium enema examination are rare. The tip of the enema catheter or distention of the colon can penetrate the wall of the colon and give rise to a localized infection (abscess) or peritonitis (generalized infection of the abdominal cavity). This usually occurs only when excessive pressure is used to infuse the barium or there is already a diseased colon that is weakened.
Double contrast Barium Enema
A Double contrast Barium Enema is a radiological exam that looks for polyps or cancer in the colon or rectum. During this procedure a physician administers a liquid with barium through the anus and into the rectum and colon. The barium compound helps to show the image of the lower gastrointestinal tract on an x-ray. This test is relatively painless. Unlike a colonoscopy, the procedure does not allow polyps or tissue samples to be removed. If something abnormal is detected, an additional test may be required for further examination. A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of this test: the single-contrast technique where barium sulfate is injected into the rectum in order to gain a profile view of the large intestine; and the double-contrast (or "air contrast") technique where air is inserted into the rectum.
Why the test is performed?
A barium enema may be performed for a variety of reasons, including to aid in the diagnosis of colon and rectal cancer (or colorectal cancer), and inflammatory disease. Detection of polyps (a benign growth in the tissue lining of the colon and rectum), diverticulum (a pouch pushing out from the colon), and structural changes in the large intestine can also be established with this test. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.
The decision to perform a barium enema is based on a person's history of altered bowel habits. These can include diarrhea, constipation, any lower abdominal pain they are currently exhibiting, blood, mucus, or pus in their stools. It is also recommended that this exam be used every five to 10 years to screen healthy people for colorectal cancer, the second most deadly type of tumor in the United States. Those who have a close relative with colorectal cancer or have had a precancerous polyp are considered to be at an increased risk for the disease and should be screened more frequently to look for abnormalities.
Side Effects and Risks
While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed: â-ª Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema. â-ª The test can be cautiously performed if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea. â-ª Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. These are all very rare.