Clinical Radiology (1991) 44, 183-184
Use of Air in Double Contrast Barium E n e m a - Is It Still Acceptable? p. N. T A Y L O R and D. E. B E C K L Y Radiodiagnostic Department, Freedom Fields Hospital, Plymouth There is conflicting evidence regarding the benefit of using carbon dioxide in a double contrast barium enema. In a double blind prospective study, 200 patients undergoing out-patient double contrast barium enemas (DCBE) were randomly allocated to receive either air or carbon dioxide (COz) insufltation. After 24 h they were requested to complete and return a questionnaire regarding abdominal pain and distension experienced following the examination. The use of CO2 reduced the incidence of severe post-DCBE pain from 27% to 7%. There was a higher incidence of severe pain in younger patients, regardless of which gas was used. The incidence of severe pain following DCBE was unrelated to the presence or absence of abdominal pain as part of the patient's symptomatology. In the light of these findings we advocate the routine use of CO2 in DCBE. Taylor, P.N. & Beckly, D.E. (1991). Clinical Radiology 44, 183 184. Use of Air in Double Contrast Barium Enema - Is It Still Acceptable?
Many patients suffer minor pain and abdominal distension associated with air insufflation for double contrast barium enema (DCBE). Less widely appreciated is the number of patients who experience severe pain following DCBE after they have left the radiology department. Discussion with medical and surgical colleagues led us to believe that complaints of such pain are quite frequent at out-patient visits after D C B E and on occasions the pain had been sufficiently severe to result in the patient calling out their general practitioner (GP). Previous studies are few but Russell (1986) recorded abdominal pain after DCBE. Coblentz et al. (1985) in an elegant double blind study found significant pain in 30% of patients after D C B E using r o o m air and showed that the incidence could be reduced to 11% when carbon dioxide (CO2) was used. Notwithstanding these results, our impression is that air is still used in D C B E in the majority of radiology departments. A study by G r a n t et al. (1986) concluded that CO2 would not be of general benefit but their opinion was based on relatively small numbers and did not take into account pain occurring after the patient had left the department. Because of these conflicting results it was felt justifiable to reassess the possible benefits of using CO2 in DCBE. PATIENTS AND M E T H O D S Two hundred and twenty-seven consecutive patients attending for out-patient D C B E gave informed consent and were included in a prospective randomized double blind study. Before each barium enema session the radiology department nurse pre-filled empty polythene enema bags with either CO2 or air according to a schedule of random numbers and labelled the bags A or B. The patient, radiographer and radiologist were unaware of the type of gas used. Double contrast enema was performed using a standard technique including the administration of muscle relaxants. Gas was insufflated in sufficient volume to produce adequate distension as judged by fluoroscopy. I f Correspondence to: Dr P. N. Taylor, Radiodiagnostic Department, St. James' Hospital, Leeds.
some deflation o f the bowel occurred between films further gas was introduced. A supine over-couch film was taken at the end of the examination and used to assess the quality of barium coating and the adequacy of distension. For each examination the radiologist recorded the clinical indication. At the end of the examination the patients were given a questionnaire which they were asked to complete after 24 h and return by post. In this questionnaire they were asked to grade pain and distension separately as either nil, mild or severe.
RESULTS
Two hundred completed protocols were obtained from the 227 patients initially enrolled in the study. In 20 cases the patients failed to return the postal questionnaire and in seven cases other aspects of the documentation were incomplete. O f the 200 patients completing the study, 103 had been randomized to receive air and 97 CO2. There were 83 males and 117 females with ages ranging from 18 to 86 years (mean 60 years). The age and sex distribution was similar for the air and CO2 groups - 1.6:1 F/M air, 1.3 : 1 F/M CO2. Mean ages were 59 years for the air, and 62 years for the CO2 groups. Severe pain was experienced by 28 out of the 103 patients who received air (27%) and seven out of the 97 patients who received CO2 (7%) (P
Use of Air in Double Contrast Barium E n e m a - Is It Still Acceptable? p. N. T A Y L O R and D. E. B E C K L Y Radiodiagnostic Department, Freedom Fields Hospital, Plymouth There is conflicting evidence regarding the benefit of using carbon dioxide in a double contrast barium enema. In a double blind prospective study, 200 patients undergoing out-patient double contrast barium enemas (DCBE) were randomly allocated to receive either air or carbon dioxide (COz) insufltation. After 24 h they were requested to complete and return a questionnaire regarding abdominal pain and distension experienced following the examination. The use of CO2 reduced the incidence of severe post-DCBE pain from 27% to 7%. There was a higher incidence of severe pain in younger patients, regardless of which gas was used. The incidence of severe pain following DCBE was unrelated to the presence or absence of abdominal pain as part of the patient's symptomatology. In the light of these findings we advocate the routine use of CO2 in DCBE. Taylor, P.N. & Beckly, D.E. (1991). Clinical Radiology 44, 183 184. Use of Air in Double Contrast Barium Enema - Is It Still Acceptable?
Many patients suffer minor pain and abdominal distension associated with air insufflation for double contrast barium enema (DCBE). Less widely appreciated is the number of patients who experience severe pain following DCBE after they have left the radiology department. Discussion with medical and surgical colleagues led us to believe that complaints of such pain are quite frequent at out-patient visits after D C B E and on occasions the pain had been sufficiently severe to result in the patient calling out their general practitioner (GP). Previous studies are few but Russell (1986) recorded abdominal pain after DCBE. Coblentz et al. (1985) in an elegant double blind study found significant pain in 30% of patients after D C B E using r o o m air and showed that the incidence could be reduced to 11% when carbon dioxide (CO2) was used. Notwithstanding these results, our impression is that air is still used in D C B E in the majority of radiology departments. A study by G r a n t et al. (1986) concluded that CO2 would not be of general benefit but their opinion was based on relatively small numbers and did not take into account pain occurring after the patient had left the department. Because of these conflicting results it was felt justifiable to reassess the possible benefits of using CO2 in DCBE. PATIENTS AND M E T H O D S Two hundred and twenty-seven consecutive patients attending for out-patient D C B E gave informed consent and were included in a prospective randomized double blind study. Before each barium enema session the radiology department nurse pre-filled empty polythene enema bags with either CO2 or air according to a schedule of random numbers and labelled the bags A or B. The patient, radiographer and radiologist were unaware of the type of gas used. Double contrast enema was performed using a standard technique including the administration of muscle relaxants. Gas was insufflated in sufficient volume to produce adequate distension as judged by fluoroscopy. I f Correspondence to: Dr P. N. Taylor, Radiodiagnostic Department, St. James' Hospital, Leeds.
some deflation o f the bowel occurred between films further gas was introduced. A supine over-couch film was taken at the end of the examination and used to assess the quality of barium coating and the adequacy of distension. For each examination the radiologist recorded the clinical indication. At the end of the examination the patients were given a questionnaire which they were asked to complete after 24 h and return by post. In this questionnaire they were asked to grade pain and distension separately as either nil, mild or severe.
RESULTS
Two hundred completed protocols were obtained from the 227 patients initially enrolled in the study. In 20 cases the patients failed to return the postal questionnaire and in seven cases other aspects of the documentation were incomplete. O f the 200 patients completing the study, 103 had been randomized to receive air and 97 CO2. There were 83 males and 117 females with ages ranging from 18 to 86 years (mean 60 years). The age and sex distribution was similar for the air and CO2 groups - 1.6:1 F/M air, 1.3 : 1 F/M CO2. Mean ages were 59 years for the air, and 62 years for the CO2 groups. Severe pain was experienced by 28 out of the 103 patients who received air (27%) and seven out of the 97 patients who received CO2 (7%) (P
