Bowel preparation for the double-contrast barium enema: how to maintain coating with cleansing?
OBJECTIVE
Poor mucosal coating, due to excess of fluid in the colon lumen, is a problem when the oral lavage method (4 litres of an iso-osmotic saline solution containing polyethylene glycol) is used as a preparation for double-contrast barium enema. Our aim was to assess the value of prior administration of sennosides to obtain a clean colon with a reduced volume of polyethylene glycol (PEG)-saline solution, but maintaining good mucosal coating.


METHODS
After a 2-day low-residue diet, three different oral preparations were compared: (i) 4 litres of a PEG-saline solution (SELG) and 15 mg of bisacodyl (116 patients, SELG-4 group); (ii) 156 mg of sennosides, 15 g of magnesium sulphate, and 2 litres of water (116 patients, SennMg group); (iii) 156mg of sennosides and 2 litres of SELG (116 patients, SennSELG group). Compliance, complaints, cleansing, mucosal coating, and fluid retention were evaluated.


RESULTS
Compliance was > 94% in every group. A higher percentage of mild nausea was observed in SELG-4 group, of mild abdominal cramping in SennMg group, of substantial abdominal cramping in SennSELG group (P < 0.02). Cleansing was better in SennSELG than in both the SELG-4 (P = 0.0003) and SennMg (P = 0.0353) group. Mucosal coating was better in SennMg than both SELG-4 (P = 0.0034) and SennSELG (P < 0.0001) group. There was more residual fluid in the SennSELG group than both in SELG-4 (P = 0.0029) and SennMg (P = 0.0059) group.


CONCLUSIONS
For colon cleansing, the combination of sennosides and PEG-saline solution was better than either the 4 litre PEG protocol or the combination of sennosides and magnesium sulphate. For mucosal coating, the protocol combining sennosides and magnesium sulphate was more effective than either protocols using the PEG-saline solution. This may be due to the interaction of residual magnesium ions in the colon lumen with the barium suspension.
Cittadini
G
G
Department of Radiology, University of Genova, Italy.
Sardanelli
F
F
De Cicco
E
E
Valle
M
M
Rosso
E
E
Parodi
R C
RC
D000368:Aged; D000880:Anthraquinones; D001466:Barium Sulfate; D001726:Bisacodyl; D002400:Cathartics; D003106:Colon / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004733:Enema; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging; D008278:Magnesium Sulfate; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011092:Polyethylene Glycols; D011859:Radiography; D012676:Senna Extract; D000081226:Sennosides; D016037:Single-Blind Method; D012965:Sodium Chloride; D007507:Therapeutic Irrigation / Q000379:methods
D000880:Anthraquinones; D002400:Cathartics; D003287:Contrast Media; D000081226:Sennosides; D001726:Bisacodyl; D001466:Barium Sulfate; D011092:Polyethylene Glycols; D012965:Sodium Chloride; D008278:Magnesium Sulfate; D012676:Senna Extract