A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO(2) on pain associated with barium enema.

Previous investigators have shown significant benefit using CO(2) for bowel insufflation. Others have suggested that the long-acting smooth muscle relaxant, Mebeverine, may be of benefit. We subjected this to a randomised double-blind trial. A total of 181 outpatients were randomised to receive either Mebeverine or placebo as pre-medication, and either air or CO(2) for bowel insufflation, thus creating four treatment groups. Visual-analogue lines were used to record pain scores before, during, and up to 8 h following the enema. All groups showed increased pain scores during the enema, with peak pain scores at the end of the examination, falling to baseline scores by 8 h. Patients receiving the combination of C0(2) and placebo had significantly lower pain scores at 1 and 4 h ( P=0.00 and P=0.014, respectively; Kruskal-Wallis test) compared with all other groups. Having Mebeverine as a pre-medication did not significantly lower pain scores compared with placebo, and decreased the amount of benefit received from the CO(2). We confirm that CO(2) is of benefit in decreasing pain during barium enema, and we recommend its routine use to improve the comfort of patients. Mebeverine is not of benefit, and its use as a pre-medication for enemas is not recommended.

Double contrast barium enema sensitivity: a comparison of studies by radiographers and radiologists.

PURPOSE: A retrospective study of histologically proven cases of colorectal cancer (CRC) was performed to assess whether the sensitivity of the radiographer-performed double contrast barium enema (DCBE) differed from that of the radiologist-performed study. MATERIALS AND METHODS: Histologically proven cases of CRC were reviewed over a 3-year period to ascertain whether: the diagnosis had been made by DCBE in the 3 years before histological diagnosis; the lesion had been correctly diagnosed; the examination had been performed by a radiologist or radiographer. RESULTS: In the 3-year period there were 478 cases with histologically proven CRC. Of these, 239 (50%) had undergone DCBE as the initial radiological investigation of the colon. Sixty-four examinations had been performed by radiographers. A correct diagnosis was made in 58 cases (90.6%), the report was equivocal in one case (1.6%), there were four false-negatives (6.25%), and one case was abandoned (1.6%). One hundred and seventy-five examinations were performed by radiologists. A correct diagnosis was made in 157 cases (89.7%), the report was equivocal in one case (0.6%), there were 16 false-negatives (9.1%), and one case was abandoned (0.6%). CONCLUSION: A sensitivity of 90.6% for radiographer-performed studies compared favourably with 89.7% for radiologist-performed studies and supports the practice of radiographers undertaking barium enemas.

Strictures of the sigmoid colon: barium enema evaluation.

PURPOSE: To assess the accuracy of radiologic interpretation, in the absence of clinical information, in the differentiation of benign and malignant sigmoid strictures at barium enema examination. MATERIALS AND METHODS: On two occasions, four independent observers retrospectively assessed examination findings in 78 patients with documented sigmoid strictures (43 benign, 35 malignant). Each stricture was graded by using a five-point scale (definitely malignant to definitely benign). RESULTS: No significant difference existed between the areas under the receiver operating characteristic curves for the two assessments with any observer. Consensus findings indicated agreement among at least three of the four observers in 68 (87%) and 66 (85%) cases at the first and second assessments, respectively. One benign stricture was called malignant at both assessments. When consensus existed, the positive predictive value for malignant strictures was 96% at both assessments (sensitivity, 63% and 66%). Nine malignant strictures were called benign, three at both assessments. When consensus existed, the positive predictive value for benign strictures was 84% and 88% at the first and second assessments, respectively (sensitivity, 88% and 86%, respectively). CONCLUSION: The differentiation between a benign and a malignant sigmoid stricture can be made in most cases at barium enema examination. When a stricture appears malignant, the diagnosis is usually correct, but caution is advised when a stricture appears benign.

Complications from inflation of a retention rectal balloon catheter in the vagina at barium enema.

We describe two complications arising from the inadvertent introduction and inflation of a retention rectal balloon catheter in the vagina. Barium entered the uterus, fallopian tubes and peritoneal cavity in one and caused a forniceal tear and venous intravasation in the other. In both cases the catheter misplacement was attributed to atrophy of the perineal body. Various recommendations have been made to reduce the risks associated with the use of balloon catheters but we wish to emphasize the importance of a digital rectal examination to define the perineal anatomy and the use of a gloved finger to guide the balloon catheter into the rectum.

Complications of barium enema examinations: a survey of UK Consultant Radiologists 1992 to 1994.

Questionnaires were sent to all Consultant Radiologists in the UK regarding complications from barium enema examinations. The 756 respondents performed a total of 738,216 examinations over the three year period 1992 to 1994. Seventy-seven Consultants (10.2%) reported a total of 82 complications including 13 deaths: an overall mortality rate of 1 in 56,786. Only three of 30 (10%) cases of bowel perforation died, as compared with nine out of 16 (56%) cases of cardiac arrhythmia. The only remaining death was a consequence of vaginal intubation. Details of all the reported complications are recorded. This was an entirely retrospective study.

Retention balloon catheters and barium enemas: attitudes, current practice and relative safety in the UK.

Balloon catheters have been associated with increased morbidity and mortality leading some to believe they should be banned, yet others find them both useful and safe if used properly. Questionnaires were sent to all Consultant Radiologists in the UK to document current practice. Particular attention focused on whether eight safety aspects are considered during their use. In this entirely retrospective study complications with both balloon and standard tip catheters were recorded during the 3-year-period 1992 to 1994 to assess their relative safety. Twenty-two percent of UK Radiologists routinely used a rectal balloon. This was not associated with any increase in mortality, but extraperitoneal rectal perforation was increased by a factor of 2.5. The routine use of retention balloon catheters may not be justified.

Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation.

Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis.

A barium enema training programme for radiographers: a pilot study.

We describe a training programme designed to instruct radiographers how to perform the double contrast barium enema (DCBE). The programme was assessed by comparing the first 50 unsupervised examinations with studies performed by senior registrars in radiology. Comparison was made by marking each study blind in terms of barium coating, colonic distension and visualisation of the colon in double contrast. A note was also made of the number of exposures, screening time, examination time and complications. No difference was found in any of these parameters when comparing the two groups. A further 50 patients were assessed at one year and this showed that standards had been maintained in terms of the above criteria. Follow-up at 3 years in the initial group has shown no missed pathology. We believe that delegation of the performance of the DCBE to radiographers is both acceptable to the patient and safe.

The acute contrast enema in suspected large bowel obstruction: value and technique.

In order to determine the value of the acute contrast enema (ACE) as compared to the plain abdominal film for the diagnosis of colonic obstruction and to determine the optimal technique for performing this examination, we reviewed 140 cases performed over a 4 year period. The study shows that when provided with the case history and the plain abdominal films of patients referred for an ACE the diagnosis of colonic obstruction can be made with a sensitivity of 84% and a specificity of 72%, whereas the ACE has a sensitivity of 96% and a specificity of 98%. The ACE resulted in two false negatives, one false positive and one technical failure, analysis of which has enabled an optimal technique for the performance of this examination to be recommended.

The value of a barium enema in the investigation of patients with rectal carcinoma.

A review of 545 patients with clinically diagnosed rectal carcinoma was conducted to determine the diagnostic usefulness of pre-operative barium enema and the frequency with which it was employed. Only 118 patients underwent pre-operative barium enema (21.7%). This successfully outlined the whole colon in 107 (90%). Synchronous carcinomas were detected in 9.3% of patients who underwent complete barium enema, compared to 4.3% of those who underwent laparotomy alone (P less than 0.05). Polyps were found in 23.4% of patients who had a barium enema but in only 14.7% of those who did not (P less than 0.05). Twenty-nine per cent of synchronous carcinomas and 11% of polyps were proximal to the descending colon and would have been beyond the reach of a flexible sigmoidoscope. Barium enema remains a useful investigation in patients with rectal carcinoma. It will outline the whole colon in most cases and will result in the detection of more synchronous carcinomas and polyps than if the surgeon relies on operative palpation alone.