Background and Aim
Currently, some countries still acknowledge double‐contrast barium enema (DCBE) as a backup confirmatory examination when colonoscopy is not feasible or incomplete in colorectal ...cancer (CRC) screening programs. This study aims to compare the performance of colonoscopy and DCBE in terms of the risk of incident CRC after negative results in the fecal immunochemical test (FIT)‐based Taiwan Colorectal Cancer Screening Program.
Methods
Subjects who had positive FITs and received confirmatory exams, either colonoscopy or DCBE, without the findings of neoplastic lesions from 2004 to 2013 in the screening program comprised the study cohort. Both the colonoscopy and DCBE subcohorts were followed until the end of 2018 and linked to the Taiwan Cancer Registry to identify incident CRC cases. Multivariate analysis was conducted to compare the risk of incident CRC in both subcohorts after controlling for potential confounders.
Results
A total of 102 761 colonoscopies and 5885 DCBEs were performed after positive FITs without neoplastic findings during the study period. By the end of 2018, 2113 CRCs (2.7 per 1000 person‐years) and 368 CRCs (7.6 per 1000 person‐years) occurred in the colonoscopy and DCBE subcohorts, respectively. After adjusting for major confounders, DCBE had a significantly higher risk of incident CRC than colonoscopy, with an adjusted HR of 2.81 (95% CI = 2.51–3.14).
Conclusions
In the FIT screening program, using DCBE as a backup examination was associated with a nearly threefold risk of incident CRC compared with colonoscopy, demonstrating that it is no longer justified as a backup examination for incomplete colonoscopy.
Barium peritonitis is an inflammatory response that occurs when barium accidentally enters the abdominal cavity during a barium test. In extreme circumstances, it has the potential to harm various ...organs and even result in death.
A 3-month-old infant was diagnosed with multiple organ failure after severe barium peritonitis.
Multiple organ dysfunction is associated with barium peritonitis.
The infant underwent surgical intervention and received ventilator support, anti-infection therapy, myocardial nutrition, liver and kidney protection, rehydration, circulation stabilization, and other symptomatic supportive care.
The patient experienced clinical death after treatment and resuscitation was unsuccessful.
Barium enema perforation complications are uncommon, but can lead to fatal injuries with a high mortality rate. This case highlights the importance of raising awareness among clinicians about the risks of gastroenterography in infants and children and actively preventing and avoiding similar serious complications. The mortality rate can be reduced by timely multidisciplinary consultation and joint management once a perforation occurs.
Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been ...successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM.
•Double-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis.•In the last few years CTC has emerged as the preferential technique to investigate the whole bowel.•Since, transvaginal ultrasound (TVS) is accurate in the diagnosis of rectosigmoid endometriosis, it may be combined with CTC to diagnose multicentric disease in patients undergoing surgical approach.
Diagnostic accuracy of double-contrast barium enema (DCBE) depends upon the barium sulfate coating efficiency in the colon.
To evaluate effects of three laxatives on barium sulfate coating efficiency ...in the large intestine, sigmoid colon, and hepatic flexure in DCBE.
This retrospective study included patients receiving DCBE after pre-procedure cleansing with Dulcolax
with castor oil (DC), Klean-Prep
(KP), or Fleet
. Patients' DCBE images were reviewed.
Among 373 cases of DCBE, 151 received DC, 147 received KP, and 75 received Fleet. For DCBE, the optimal extent of barium sulfate residue coated on the wall of the large intestine is less than one-fourth of bowel wall width; the DC group had a higher percentage of less than one-fourth of bowel wall than that of the KP or Fleet group (both p < 0.0167). DC, KP and Fleet have comparable barium sulfate coating efficiency in the sigmoid colon. However, in the hepatic flexure, the DC group had a higher percentage of barium sulfate coating without interruption than that of the KP or Fleet groups (both p < 0.0167).
DC has a better barium sulfate coating efficiency in the hepatic flexure compared with KP and Fleet.
Dolichocolon has been described as a developmental variant and is characterized by redundancy of the colon. Diagnosis is based off clinical symptoms and barium enema or CT-colonography. This ...redundancy is often seen in the adult and elderly population, with pediatric prevalence limited to case reports. Information regarding radiologic evaluation is limited, as most cases are documented outside of the radiology literature. This case report demonstrates a complex course of transient symptoms of constipation, obstruction, and suspected volvulus in a 1-month-old with dolichocolon. A retrospective review of the images offers insight into gaining suspicion of this variant in radiographs and fluoroscopic exams.
Background and objective
The cardinal diagnostic sign of congenital aganglionic megacolon, or Hirschsprung’s disease (HD), is an aganglionic segment of the distal colon or rectum. To determine the ...surgical planning of a radiological transition zone (TZ) in HD, this study investigated the association between a radiological TZ and the bowel resection length.
Methods
A prospective observational study was conducted in children (
n
= 192) with suspected HD determined by radiological TZ on contrast barium enema, and who underwent pull-through operations. The bowel resection length was ≥10 cm above the proximal radiological TZ levels and confirmed by intraoperative frozen sections. In the contrast enema, the presence and level of a radiological TZ were recorded. Correlation of the TZ features with ganglion cells assessed by immunostaining of neuronal nuclei (NeuN) and the odds ratio were calculated.
Results
The sensitivity and specificity for diagnosing HD by the presence of a radiological TZ were 86.9 and 92.1%, respectively; Youden’s index was 79.0%. The positive and negative predictive values were 91.7 and 87.6%. The kappa value indicating an association between TZ and HD was 0.776 (
P
< 0.05). The correlation rate between a radiological TZ and the pathological results was 88.5% in the rectosigmoid colon and 44.4% in the descending colon, and was higher in children older than 3 months (85.3%) than in infants (69.0%).
Conclusion
A preoperatively determined radiological TZ has potential value to identify the length of resected bowel in patients with HD, and it also has a high predictive value for diagnosis of HD.
OBJECTIVE
Acute diverticulitis (AD) is becoming a health concern with its increasing incidence. One of the accepted theories of the possible causes of diverticular perforation is the impaction of ...fecal residuals into some diverticula. We aimed to evaluate whether barium impaction had a negative effect by promoting diverticular inflammation or rupture and thereby AD recurrence.
METHODS
A retrospective cohort study (January 2005–December 2015) was conducted at the Reina Sofia University Hospital of Cordoba, Spain with follow‐up for patients received barium enema or not after their first episode of AD. Factors related to disease recurrence and its severity were analyzed.
RESULTS
In total, 349 patients were included and subdivided into the barium enema group (n = 141) and control group (n = 208), respectively. In the studied cohort, 72 (20.6%) patients suffered recurrence of AD, which was almost twice as frequent in the barium enema group than in the control group (27.7% vs 15.9%, P = 0.008). Patients who had undergone barium enema were more likely to present a higher Hinchey grade at recurrence than that observed in the index presentation (30.8% vs 9.1%, P = 0.024). Age <50 years, female sex, absence of treatment with rifaximin and especially barium enema, showed a trend to a higher probability of AD recurrence over time. However, no statistically significant differences were found.
CONCLUSIONS
We failed to conclude that barium enema increased AD recurrence. Patients undergo barium enema are more likely to show a higher Hinchey grade at recurrence than that observed in their index presentation.
This study aimed to develop a food program and evaluate the effectiveness of the food program with phone recall (FPPR) for double-contrast barium enema (DCBE) bowel preparation.
Sixty outpatients ...with appointments for their first DCBE were recruited and divided into a standard protocol and FPPR groups. They were requested to prepare bowel cleansing following the guideline of each group. The colon cleansing score, proportion of rejected patients, fatigue score, and satisfaction were evaluated on the examination day.
The colon cleansing score and proportion of rejected patients were significantly improved in the FPPR group. Moreover, a significant improvement of fatigue score and bowel preparation satisfaction were also observed in the FPPR group.
The implementation of FPPR on the DCBE appointment service might improve bowel cleansing and patients’ satisfaction while diminishing fatigue and number of rejected patients on the DCBE procedure.
•Bowel preparation using FPPR improved colon cleansing in DCBE patients which decreased the proportion of rejected patients on the examination day.•Bowel preparation using FPPR improved patient's satisfaction and attenuated bowel preparation induced fatigue.•The diet menu in the food program was simple and convenient to practice, resulting in better compliance to the preparation method.
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