Double Contrast Barium Enemas – How Frequent are Reports Inconclusive and what Action is Taken?

Introduction: Double contrast barium enema (DCBE) in combination with flexible sigmoidoscopy (FS) is an adequate means of visualizing the colorectum. Irrespective of financial implications of inconclusive investigations, clinicians are faced with the problem of ongoing management. The aim of this study was to evaluate actual numbers.

Methods: Reports of all DCBEs performed in 2001 were obtained. Reports were divided into 3 groups: i. diagnostic (normal enema / definite mucosal lesion); ii. complete technical failure; iii. inconclusive. Latter reports were subdivided into 4 groups according to the reason: a. poor bowel preparation; b. diverticular disease (DD); c. possible polyp advising endoscopic visualization; d. miscellaneous group. Charts of patients in 'inconclusive' group were reviewed.

Results: Of 2036 DCBEs performed in 2001, radiologists were confident with the enema (definite pathology or normal) in 1749 (86%). There were 77 (4%) technical failures and 210 (10%) 'inconclusive' DCBE's. For inconclusive enemas, reasons were poor bowel preparation in 58 (23%), DD in 70 (33%), possible mucosal polyp recommending 'direct visualisation' in 54 (26%) and 28 (13%) 'other' reasons. 30 (14%) patients had FS pre-DCBE. In 96 (46%) patients further investigations were deemed inappropriate at review. In 70 (33%) patients further investigations were arranged, 35 from group c. Of 70 endoscopies, 19 (27%) had an abnormality correlating to DCBE; 10 of these were from group c.

Conclusion: DCBE reports are frequently inconclusive. Yield of significant pathology with further investigations is low. Faced with an inconclusive DCBE, review and clinical risk reassessment is recommended before arranging further investigations.