Whole Gut Irrigation: An inadequate preparation for double contrast barium enema examination

A clean large bowel is a prerequisite for successful barum enema examination. Since the method of whole gut irrigation has been claimed to be very effective and convenient in preparing the colon for surgery, it was thought that it would be interesting to assess its efficacy in the preparation of the bowel for double contrast barium enema examination. Twenty outpatients of similar age, sex distribution, and symptomatology presenting for barium enema examination by a modification of the Malmo double contrast technique were randomly allocated to two groups. The “normal” preparation group ate a restricted diet and took a laxative the day before. Immediately before the examination the colon was washed out using colonic lavage. The “irrigation” group omitted the laxative. The colon was cleansed with warmed isotonic, saline which was infused down a nasogastric tube until the effluent was clear or 10 to 12 liters had been infused. The average amount infused was 10.5 ± 1.1 liters over a mean time of 1.64 ± 0.2 hr. The examinations were performed by one radiologist. Three radiologists (without knowledge of the preparation used) independently assessed all radiographs according to the amount of water and feces remaining, the quality of mucosal coating, the amount of barium present, and terminal ileum filling. When the results of the three radiologists were pooled, mucosal coating and definition were found to be significantly worse in the irrigated patients (P < 0.025 Mann-Whitney w-test). There were also significant increases in residual water, amount of barium present in the colon, and terminal ileum filling (P < 0.05) in the irrigated patients, although no difference was noted in the amount of residual feces. It is concluded that the whole gut irrigation is not a satisfactory preparation for double contrast barium enema examination.