How can barium enema preparation be improved. What are the benefits of using oral intestinal lavage solution with prokinetic agents. Why is effective bowel cleansing crucial for accurate barium enema imaging.

Understanding Barium Enema and Its Preparation Challenges

A barium enema is a diagnostic imaging procedure used to examine the colon and rectum. The procedure involves introducing a contrast material (barium sulfate) into the large intestine through the rectum, which allows for detailed X-ray images of the bowel. However, the effectiveness of this procedure heavily relies on proper bowel preparation.

Traditionally, the modified Brown’s method has been widely used in Japan for barium enema preparation. This method typically involves dietary restrictions and the use of laxatives. However, it has been observed that in some cases, the cleansing effect is not satisfactory, even when patients adhere to the recommended diet.

Why is effective bowel cleansing crucial?

Thorough bowel cleansing is essential for several reasons:

• It ensures clear visibility of the colon walls during the imaging process
• It allows for better detection of small lesions or abnormalities
• It reduces the risk of misdiagnosis due to fecal matter being mistaken for pathological findings
• It enhances the overall quality and accuracy of the barium enema examination

Innovative Approach: Oral Intestinal Lavage Solution with Prokinetic Agents

To address the limitations of traditional preparation methods, researchers have explored the use of oral intestinal lavage solutions combined with prokinetic agents. One such study, conducted by Shinichi Futei and colleagues, investigated the efficacy of polyethylene glycol electrolyte lavage solution (PEG-ELS) in combination with mosapride, a prokinetic agent.

What is PEG-ELS?

PEG-ELS is an osmotically balanced electrolyte solution that promotes bowel cleansing by drawing water into the intestines and stimulating evacuation. It is commonly used for colonoscopy preparation and has shown promising results in barium enema preparation as well.

How does mosapride enhance the cleansing process?

Mosapride is a prokinetic agent that enhances gastrointestinal motility. By stimulating the movement of the digestive tract, it can potentially improve the distribution and effectiveness of the lavage solution, leading to more thorough bowel cleansing.

Comparing PEG-ELS with Mosapride to the Modified Brown’s Method

The study by Futei et al. compared the efficacy of PEG-ELS with mosapride to the traditional modified Brown’s method. The researchers administered mosapride and PEG-ELS using four different protocols, assessing the outcomes based on two primary factors:

1. The amount of remaining feces in the colon
2. The adequacy of barium coating on the intestinal walls

The results of this comparison revealed significant insights into the effectiveness of the new preparation method.

What were the key findings of the study?

The study yielded several important observations:

• Methods involving separate administration of mosapride before and after PEG-ELS intake showed superior effectiveness compared to the modified Brown’s method
• The new approach resulted in improved bowel cleansing and better barium coating of the intestinal walls
• Lesion detection rates were comparable between the new method and the modified Brown’s method, indicating no compromise in diagnostic accuracy

Optimal Protocol for PEG-ELS and Mosapride Administration

Based on the study’s findings, the most effective protocol for barium enema preparation involved a specific timing and sequence of mosapride and PEG-ELS administration.

What is the recommended protocol for optimal bowel cleansing?

The study suggests the following approach:

1. Administer mosapride before PEG-ELS intake
2. Have the patient consume the prescribed amount of PEG-ELS
3. Administer another dose of mosapride after PEG-ELS intake

This protocol was found to be more effective in achieving thorough bowel cleansing compared to other methods tested in the study.

Benefits of the New Preparation Method

The innovative approach of combining PEG-ELS with mosapride offers several advantages over traditional preparation methods for barium enema examinations.

What are the primary benefits of using PEG-ELS with mosapride?

• Improved bowel cleansing: The combination results in more effective removal of fecal matter from the colon
• Enhanced barium coating: Better cleansing allows for more uniform and complete coating of the intestinal walls with barium sulfate
• Potential for increased diagnostic accuracy: Clearer images may lead to improved detection of subtle abnormalities
• Patient comfort: The new method may be better tolerated by patients compared to more aggressive cleansing regimens
• Efficiency: The protocol can potentially reduce the need for repeat examinations due to inadequate preparation

Implications for Clinical Practice

The findings of this study have significant implications for the field of diagnostic radiology and gastroenterology.

How might this new preparation method impact clinical practice?

The adoption of PEG-ELS with mosapride for barium enema preparation could lead to several positive outcomes:

• Improved image quality: Clearer images can enhance the diagnostic value of barium enema examinations
• Increased efficiency: Better preparation may reduce the time needed for image interpretation and decrease the likelihood of inconclusive results
• Enhanced patient experience: A more effective and potentially more comfortable preparation method could improve patient compliance and satisfaction
• Standardization of practice: Adoption of this protocol could lead to more consistent preparation across different healthcare facilities

Considerations and Future Research

While the results of the study by Futei et al. are promising, it’s important to consider the need for further research and potential limitations.

What aspects of this new preparation method require further investigation?

Several areas warrant additional study:

• Large-scale clinical trials to confirm the efficacy and safety of the PEG-ELS with mosapride protocol
• Comparison of this method with other emerging bowel preparation techniques
• Investigation of potential side effects or contraindications, especially in patients with specific medical conditions
• Optimization of dosing and timing for different patient populations
• Cost-effectiveness analysis comparing the new method to traditional preparation techniques

Exploring Alternative Prokinetic Agents

While the study focused on mosapride as the prokinetic agent of choice, it’s worth considering other potential candidates that could enhance bowel cleansing for barium enema preparations.

What other prokinetic agents might be effective in bowel preparation?

Several prokinetic agents could potentially be used in combination with PEG-ELS:

• Metoclopramide: A widely used prokinetic that enhances upper gastrointestinal motility
• Domperidone: Another prokinetic agent that may have fewer central nervous system side effects compared to metoclopramide
• Prucalopride: A selective serotonin (5-HT4) receptor agonist that stimulates colonic motility
• Itopride: A dopamine D2 antagonist with acetylcholinesterase inhibitory actions, which may enhance gastrointestinal motility

Future studies comparing the efficacy of these agents in combination with PEG-ELS could provide valuable insights into optimizing barium enema preparation protocols.

How might different prokinetic agents affect patient tolerability?

The choice of prokinetic agent can impact patient experience in several ways:

• Side effect profiles: Different agents may have varying incidences of side effects such as headache, dizziness, or gastrointestinal discomfort
• Onset of action: Some agents may work more quickly than others, potentially affecting the timing of the preparation protocol
• Duration of effect: Longer-acting agents might provide more sustained bowel stimulation throughout the preparation process
• Interactions with other medications: Consideration must be given to potential drug interactions, especially in patients with multiple comorbidities

Adapting Preparation Methods for Special Patient Populations

While the PEG-ELS with mosapride protocol shows promise, it’s important to consider how this method might need to be modified for specific patient groups.

Which patient populations might require special considerations in barium enema preparation?

Several groups may need adapted protocols:

• Elderly patients: May have reduced gut motility and be more sensitive to the effects of prokinetic agents
• Patients with renal impairment: May require careful electrolyte monitoring when using PEG-ELS
• Individuals with inflammatory bowel disease: May need gentler preparation methods to avoid exacerbating their condition
• Pediatric patients: Dosing and administration techniques may need to be adjusted based on age and weight
• Patients with diabetes: May require close monitoring of blood glucose levels during the preparation process

Tailoring the preparation protocol to these special populations could enhance the safety and efficacy of barium enema examinations across a broader range of patients.

Integrating New Preparation Methods with Emerging Imaging Technologies

As imaging technologies continue to advance, it’s crucial to consider how improved bowel preparation methods can complement these developments.

How might enhanced bowel preparation impact advanced imaging techniques?

Improved preparation could synergize with emerging technologies in several ways:

• CT colonography: Better cleansing could enhance the accuracy of virtual colonoscopy techniques
• Dual-energy CT: Clearer images might allow for more precise material differentiation and characterization of lesions
• AI-assisted image interpretation: Enhanced image quality could improve the performance of machine learning algorithms in detecting abnormalities
• 3D reconstruction: Thorough cleansing could allow for more accurate three-dimensional modeling of the colon

As these technologies become more prevalent, optimized bowel preparation methods will play a crucial role in maximizing their diagnostic potential.

Patient Education and Compliance

The success of any bowel preparation method heavily relies on patient understanding and adherence to the protocol. Effective patient education is crucial for achieving optimal results with the PEG-ELS and mosapride method.

What strategies can improve patient compliance with the new preparation protocol?

Several approaches can enhance patient adherence:

• Clear, written instructions: Provide patients with step-by-step guides detailing the timing and dosage of medications
• Visual aids: Use diagrams or videos to illustrate the preparation process and expected outcomes
• Reminder systems: Implement automated text or phone reminders to help patients stay on schedule
• Support hotlines: Offer a dedicated phone line for patients to ask questions or address concerns during the preparation process
• Pre-procedure counseling: Schedule brief educational sessions to explain the importance of proper preparation and address patient concerns

By focusing on patient education and support, healthcare providers can maximize the effectiveness of the new preparation method and improve overall examination outcomes.

Economic Considerations of Implementing New Preparation Methods

While the clinical benefits of improved bowel preparation are clear, it’s also important to consider the economic implications of adopting new protocols.

What are the potential economic impacts of implementing PEG-ELS with mosapride for barium enema preparation?

Several factors could influence the economic aspects of this new method:

• Medication costs: The combined cost of PEG-ELS and mosapride compared to traditional preparation methods
• Reduced need for repeat examinations: Potential cost savings from fewer inconclusive or inadequate studies
• Improved diagnostic accuracy: Possible reduction in downstream costs related to missed diagnoses or unnecessary additional testing
• Staff training: Initial costs associated with educating healthcare providers on the new protocol
• Patient satisfaction: Potential increase in patient volume due to improved experience and word-of-mouth recommendations

A comprehensive cost-effectiveness analysis would be valuable in determining the long-term economic impact of adopting this new preparation method across healthcare systems.

Conclusion

The innovative approach of using PEG-ELS in combination with mosapride for barium enema preparation represents a significant advancement in diagnostic imaging of the colon. By improving bowel cleansing and enhancing barium coating, this method has the potential to increase the accuracy and reliability of barium enema examinations.

As research in this area continues, it is likely that we will see further refinements to the protocol, exploration of alternative prokinetic agents, and adaptations for special patient populations. The integration of these improved preparation methods with advancing imaging technologies promises to enhance our ability to detect and diagnose colorectal abnormalities with greater precision.

Ultimately, the goal of these advancements is to improve patient care by providing more accurate diagnoses, reducing the need for repeat examinations, and enhancing the overall patient experience. As healthcare providers and researchers continue to innovate in the field of gastrointestinal imaging, patients stand to benefit from more effective, comfortable, and reliable diagnostic procedures.

[New preparation method for barium enema: efficacy and administration of oral intestinal lavage solution with gastrointestinal prokinetic agent]

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. 2004 Jan;64(1):22-30.

[Article in

Japanese]

Shinichi Futei 
¹
, Yoshinori Sugino, Sachio Kuribayashi, Yutaka Imai, Fumiaki Ueno, Toshifumi Hibi, Toru Mitsushima

Affiliations

Affiliation

• ¹ Department of Radiology, Keio University School of Medicine.

• PMID:

  14994507

[Article in

Japanese]

Shinichi Futei et al.

Nihon Igaku Hoshasen Gakkai Zasshi.

2004 Jan.

. 2004 Jan;64(1):22-30.

Authors

Shinichi Futei 
¹
, Yoshinori Sugino, Sachio Kuribayashi, Yutaka Imai, Fumiaki Ueno, Toshifumi Hibi, Toru Mitsushima

Affiliation

• ¹ Department of Radiology, Keio University School of Medicine.

• PMID:

  14994507

Abstract

The modified Brown’s method is commonly used in Japan as preparation for barium enema; however, in a few cases, its cleansing effect is not satisfactory even with the use of adequate diet. To develop a new method of preparation for barium enema, we examined the use of an oral intestinal lavage solution (PEG-ELS) with mosapride and compared it with the modified Brown’s method. We administered mosapride and PEG-ELS by four different methods. These methods were assessed by the amount of remaining feces and the adequacy of barium coating. Methods in which mosapride was taken separately before and after the intake of PEG-ELS were more effective than the method using mosapride and the modified Brown’s method. Lesion detection was almost the same as that with the modified Brown’s method. In conclusion, preparation for barium enema using mosapride before and after PEG-ELS intake is more effective than the modified Brown’s method.

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Barium Enema: Purpose, Procedure & Risks

Barium Enema: Purpose, Procedure & Risks

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Medically reviewed by Deborah Weatherspoon, Ph. D., MSN — By Brian Krans — Updated on July 9, 2017

What Is a Barium Enema?

A barium enema is a type of X-ray imaging test that allows doctors to examine your lower intestinal tract. It involves delivering a contrast solution that contains the metallic element barium into your rectum while a technician takes X-ray images of the area. The barium solution will be delivered using an enema — a process in which your doctor pushes a liquid into your rectum through your anus.

The barium solution helps to improve the quality of the X-ray images by highlighting certain areas of tissue. The X-ray used in this procedure is known as fluoroscopy. It allows the radiologist to see your internal organs in motion by tracking the flow of the barium solution through your intestinal tract.

The test doesn’t require painkillers or sedation, but there may be moments of slight discomfort.

Your doctor may order a barium enema if they suspect an abnormality in your lower gastrointestinal (GI) tract. There are numerous conditions and symptoms that could prompt your doctor to examine your lower GI tract, including:

• abdominal pain
• blood in your stools
• a change in your bowel movements
• Crohn’s disease
• chronic diarrhea
• colorectal cancer
• diverticulitis
• irritable bowel syndrome
• polyps
• rectal bleeding
• a twisted loop of the bowels (volvulus)
• ulcerative colitis

Your doctor will ask you to cleanse your bowels the night before your test. This may include using laxatives or taking an enema at home.

You shouldn’t eat anything after midnight the night before your procedure. On the day of the procedure, you can drink clear liquids, such as water, tea, juice, or broth. This is to ensure that your colon is clear of any stool, which could show up in the X-ray images. Tell your doctor if you’ve been having problems with your bowel movements prior to the test.

A barium enema typically takes between 30 and 60 minutes and is performed at a hospital or specialized testing facility. You’ll change into a hospital gown and remove any jewelry or other metal from your body. Metal can interfere with the X-ray process.

You’ll be positioned on an exam table. X-rays will be taken to ensure that your bowels are clear. This may also involve a physical rectal exam.

The radiologist will then insert a small tube into your rectum and introduce the barium and water mixture. The radiologist may gently push air into your colon after the barium has been delivered in order to allow for even more detailed X-ray images. This is called an air-contrast barium enema.

The technician will instruct you to hold still and hold your breath while the X-ray images are taken. You’ll most likely be repositioned several times to take pictures of your colon from different angles. This may cause you some discomfort and cramping, but it’s typically mild.

If you’re having trouble keeping the solution in your colon, alert the technician.

After the procedure, the majority of the barium and water will be removed through the tube. The rest you’ll pass in the bathroom.

The results are typically categorized as negative or positive. A negative result means that there were no abnormalities found. A positive result means that abnormalities were found. This usually means that further testing will be required.

Your doctor will discuss your results with you and the next steps.

Any test involving radiation carries a slight risk of cancer, including X-rays. However, the benefit of an accurate diagnosis outweighs the risks from the small amount of radiation you’ll be exposed to during the test. Remember that many things you do regularly, such as flying in an airplane, expose you to much more radiation than an X-ray.

If you are pregnant or believe you may be pregnant, tell your doctor. X-rays are not recommended for pregnant women because the radiation could harm your unborn child.

If it’s possible you have a tear, also called a perforation, in your colon, your doctor may opt for a contrast solution with iodine in it. This solution causes fewer potential complications if it leaks out of your colon.

The most common risk of a barium enema is an allergic reaction to the barium solution. Tell your doctor about any allergies you have.

Other rare complications from a barium enema may include:

• inflammation of the tissues around your colon
• obstruction of your gastrointestinal tract
• a perforated colon
• a tear in your colon wall

After the exam you can go about your day as you normally would. You may resume a normal diet but you should drink lots of water and increase your fiber intake. This means increasing how much water you drink and eating foods like whole-wheat pasta, beans, peas, and raspberries. Sometimes a laxative is needed to help remove the barium.

For a few days after the procedure, you may notice that your stools are white or lighter in color than normal. This is caused by the barium and is considered normal. Your rectum and anus may be sore from the procedure.

If you have difficulty or pain with bowel movements, fever, or rectal bleeding, call your doctor. If you do not have a bowel movement for two days after the exam or are unable to pass gas, call your doctor.

Last medically reviewed on January 14, 2016

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Barium Enema. (n.d.)
  hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/barium_enema_92,P07687/
• Barium Enema Examination. (n.d.)
  asrt.org/docs/default-source/patientpages/barenema_papg.pdf
• Mayo Clinic Staff. Barium enema. (2011, June 18)
  mayoclinic.com/health/barium-enema/MY00619
• Radiation exposure during commercial airline flights. (n.d.)
  hps.org/publicinformation/ate/faqs/commercialflights.html

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Medically reviewed by Deborah Weatherspoon, Ph.D., MSN — By Brian Krans — Updated on July 9, 2017

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Barium sulfate for fluoroscopy – instructions for use, doses, side effects, reviews of the drug:

0.002 ‰

Analogs

All forms of release, dosages, registration certificates, drug manufacturers, drug characteristics

Barium sulfate for fluoroscopy (powder for suspension for oral administration), instructions for medical use RU No. Р N000252/01

Last modified: 08/15/2017

Contents

• Active substance
• ATX
• Pharmacological group
• Dosage form
• Compound
• pharmachologic effect
• Description of the dosage form
• Pharmacokinetics
• Pharmaco-therapeutic group
• Indications
• Contraindications
• Use during pregnancy and lactation
• Dosage and administration
• Side effects
• Interaction
• special instructions
• Release form
• Terms of dispensing from pharmacies
• Storage conditions
• Best before date
• Reviews

Active ingredient

Barium sulfate

ATX

V08BA02 Barium sulfate without suspending agent

Pharmacological group

Radiocontrast agents

Dosage form

Powder for oral suspension.

Composition

The active ingredient in is barium sulfate.

Radiocontrast agent. Envelops the mucous membrane of the digestive tract and provides a clear image of the microrelief of the mucous membrane. Increases image contrast in x-ray studies of the gastrointestinal tract. The maximum contrast of the esophagus, stomach and duodenum is achieved immediately after oral administration, the small intestine – after 15–90 min (depending on the rate of gastric emptying and the viscosity of the drug). The greatest visualization of the distal small and large intestine depends on the position of the body and hydrostatic pressure.

Description of dosage form

White or almost white, fine, odorless loose powder.

Pharmacokinetics

Low toxicity. It is not absorbed from the gastrointestinal tract and does not enter the systemic circulation. Completely excreted through the intestines after 24-48 hours.

Pharmacotherapeutic group

Radiocontrast agent.

Indications

X-ray examination of the pharynx, esophagus, stomach and intestines (including double contrast method).

Contraindications

Hypersensitivity; violation of the integrity of the walls of the gastrointestinal tract (suspicion of it), esophagotracheal fistulas; swallowing disorder, intestinal obstruction, constipation, stenosis of the esophagus, bleeding from the organs of the gastrointestinal tract; condition after surgical interventions on the organs of the gastrointestinal tract; malabsorption syndrome, food allergy.

With caution

General serious condition of the patient; bronchial asthma.

Use during pregnancy and lactation

Not recommended during pregnancy. If it is necessary to conduct a study during lactation, breastfeeding should be stopped within 24 hours after the study.

Dosage and administration

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Inside, for x-ray examination of the pharynx, esophagus, stomach and small intestine: barium sulfate for fluoroscopy is used in the form of an aqueous suspension prepared immediately before the x-ray examination. To prepare a suspension from a powder, mix it with warm boiled or distilled water in a ratio of 2:1 to 4:1 for adults and from 1:1.5 to 1:2 for children and mix thoroughly for 4-5 minutes (possibly with using a mixer), the dose for adults per study is 300 ml, for children – 50-100 ml.

Side effects

Allergic reaction, constipation; isolated cases of the so-called “barium” appendicitis are described.

When using gas-forming substances in the process of double contrasting – discomfort in the epigastric region.

Interactions

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Not marked.

Special instructions

For double contrasting in adults and older children (double contrasting is not advisable in younger children), immediately before the examination, the patient is given, depending on age, 1.5–3.5 g of baking soda (in solution or powder), which is quickly washed down with a solution of 1-3 g of citric acid. The total volume of distilled water should not exceed 7–15 ml. Can be used to study intestinal motility in children. After oral administration, the suspension passes through the small intestine in children in 1-2 hours, which makes it possible to study the structure and motor function of the small intestine in a short time and, thereby, to abandon the special methods of its study. The duration of the passage of the suspension through the colon is 4 hours, which significantly reduces the time of inspection of the intestine and reduces the radiation exposure by 2 times.

Presentation

Powder for suspension for oral administration.

100 g in plastic cups. Each cup is hermetically sealed with an aluminum foil lid.

A cup with the drug, together with instructions for use, is placed in a cardboard box.

For inpatient use, drug cups are placed in cartons of 10, 20, 30, 40, 50, 60, 90, or 120 pieces, along with the appropriate number of instructions for use.

Terms of dispensing from pharmacies

At the request of medical institutions.

Storage conditions

Store in a dry place.

Keep out of reach of children.

Shelf life

5 years.

Do not use after the expiry date which is stated on the packaging.

Update date: 03/24/2023

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instructions for use, price, analogues, composition, indications

active substance – barium sulfate.

White or almost white, fine, odorless powder.

Radiopaque agent. Envelops the mucous membrane of the digestive tract and provides a clear image of the microrelief of the mucous membrane. Increases image contrast in x-ray studies of the gastrointestinal tract. The maximum contrast of the esophagus, stomach and duodenum is achieved immediately after oral administration, the small intestine – after 15-90 min (depending on the rate of gastric emptying and the viscosity of the drug). The greatest visualization of the distal small and large intestine depends on the position of the body and hydrostatic pressure.

Low toxicity. It is not absorbed from the gastrointestinal tract and does not enter the systemic circulation. Completely excreted through the intestines after 24-48 hours.

Used as a radiocontrast agent for visualization of the upper gastrointestinal tract (esophagus, stomach, duodenum) both by conventional X-ray and by double contrast.

Hypersensitivity; violation of the integrity of the walls of the gastrointestinal tract (suspicion of it), esophagotracheal fistulas; swallowing disorder, intestinal obstruction, constipation, stenosis of the esophagus, bleeding from the organs of the gastrointestinal tract; condition after surgical interventions on the organs of the gastrointestinal tract; malabsorption syndrome, food allergy; atresia; ischemic and necrotizing enterocolitis; injury or chemical burns of the gastrointestinal tract.

Carefully.

The general serious condition of the patient; bronchial asthma, dehydration.

Not recommended during pregnancy. If it is necessary to conduct a study during lactation, breastfeeding should be stopped within 24 hours after the study.

Inside, for x-ray examination of the pharynx, esophagus, stomach and small intestine: barium sulfate for fluoroscopy is used in the form of an aqueous suspension prepared immediately before the x-ray examination. To prepare a suspension from a powder, mix it with warm boiled or distilled water in a ratio of 2:1 to 4:1 for adults and from 1:1.5 to 1:2 for children and mix thoroughly for 4-5 minutes (possibly with using a mixer), the dose for adults per study is 300 ml, for children – 50-100 ml.

From the digestive system: barium appendicitis, constipation; at

the use of gas-forming substances in the process of double contrasting – discomfort in the epigastric region.

Allergic reactions: urticaria, erythema, rash.

Barium sulfate is biologically inert and does not interact with other drugs. However, the presence of barium sulfate in the gastrointestinal tract may affect the absorption of other drugs taken at the same time.

Influence on the ability to drive a car or other mechanisms

Does not affect.

– The drug should be taken under medical supervision.

– Do not use in patients during and up to 4 weeks after radiotherapy to the rectum or prostate.

– After using barium sulfate to prevent constipation, it is recommended to drink an increased amount of fluid.

– Caution should be exercised when using barium sulfate in children, elderly and debilitated patients

– For double contrasting in adults and older children (double contrasting is not advisable in young children), immediately before the study, the patient is given, depending on age, 1.5-3.5 g of baking soda (in solution or powder), which quickly washed down with a solution of 1-3 g of citric acid.