Barium Enema

• A barium enema (lower GI series) is an X-ray procedure used to define the anatomy of the large intestine (colon) and the rectum.
• A barium enema involves filling the colon and rectum with a white liquid material (barium) often followed by air (double-contrast barium enema).
• The risks of barium enema include discomfort, radiation exposure, and perforation of the colon.
• Women who are or may be pregnant should notify the doctor requesting the procedure and the radiology staff because of the risk of radiation exposure to the fetus.

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, polyps, dilation of the colon, Hirschsprung disease in infants, and colon cancers.

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.

Any internal or external materials that make an X-ray image less clear can interfere with the accuracy of a barium enema. Therefore, before undergoing a barium enema (lower GI), it is important to eliminate as much fecal material from the colon and rectum as is possible. Prior to the examination, a clear liquid diet and cleansing enemas often are used to empty the colon. Further medications that help evacuate the bowel are usually used. This is called a bowel prep. External materials such as extra clothing, metallic devices, or jewelry are removed prior to the test. A radiologist (a doctor specializing in the use and interpretation of X-rays) and a radiology technologist work perform the procedure on the patient.

• A barium enema involves filling the colon and rectum with a white liquid material (barium) through a catheter (tube) inserted into the rectum through the anus. It is normal during the procedure to feel some fullness or mild discomfort in the abdomen.
• Subsequently, an X-ray machine is placed in front of the patient with X-ray film behind.
• Images of the colon then are obtained by exposing the abdomen to the radiation. The contrast in density between the barium-filled colon and other structures of the abdomen are apparent on the X-ray film and give an excellent outline of the colon.
• The radiologist also will use a fluoroscope, an X-ray device on which the barium can be seen in motion flowing into the colon.
• Further static images of the colon then are obtained on plain X-ray film or digital computerized image.
• The barium then may be drained so that only a small amount of barium remains sticking to the lining of the colon, and air is infused into the colon to distend it.
• Further X-rays then are taken which give more detail of colon's lining than the X-rays of the barium-filled colon. This latter procedure is called a double contrast barium enema since both air and barium are used to provide the images. Polyps and small cancers are more readily found using this technique (called an air contrast barium enema).
• A barium enema can take anywhere from fifteen minutes to an hour depending on the problem being studied and the particular anatomy of the patient's colon.

After the X-ray films are developed by the radiology technologist, they are transmitted to the radiologist, who interprets the body structures visualized on the X-ray film. An interpretation and report of the barium enema is forwarded to the doctor who requested the test usually within one to two days. The doctor then can review the results of the report with the patient. The actual films of the examination also can be sent to the health care practitioner if necessary.