Barium enema or colonoscopy?
Both have their merits and uses. With the increased availability of colonoscopy, GP's often ask which to use.
The following may help:
Both require rather aggressive bowel prep. This will vary between Xray and Endoscopy units from a one-day prep to an arduous two-day prep, and from a few hundred cc to 4 litres. None are pleasant and they may cause hypokalaemia and/or dehydration.
No anaesthesia is used for a Barium enema and it is usually a very uncomfortable examination.
Sedation is usually used for a colonoscopy, gastroscopy and occasionally for flexible sigmoidoscopy. IV sedation incorporating hypnotics, narcotics and antispasmodics are used for endoscopy. This can be quite dangerous in the elderly, especially if hypokalaemia has occurred.
We offer an anaesthetic assist to our patients as it guarantees comfort, is safer and is covered by insurance. For patients who have had a surveillance colonoscopy before, with easy anatomy, we will do the procedure under light sedation to keep the costs down.
Afterwards, patients are often very uncomfortable because of retained insufflated air. It is therefore worth going that extra distance to try to remove as much air as possible.
After a Colonoscopy
If any form of sedation has been used, the patient is not allowed (by law) to drive, so transport is required. The medication makes the patient forgetful, so they or their relative are given a brief report on leaving. A full discussion by phone or in person follows the next day.
Nasty findings are communicated immediately to the patient's family doctor, to avoid embarrassment if patients call in a panic.
There is no special diet to follow. Also, as no barium has been used, there is no constipation and no carthartics are needed after endoscopy.
Indications and Complications
The accuracy rate for carcinoma is similar, whether a Barium enema or colonoscopy has been used. Endoscopy is far superior for polyps and inflammation. Of course, the polyp can be removed or biopsied at the same time with colonoscopy.
A Barium enema gives a permanent outline of anatomy and the extent of the disease, which is useful in diverticulitus. Sometimes the anatomy of the colon is such that a full view of the bowel is not possible with colonoscopy, but a Barium enema will usually see the entire colon.
Occasionally the radiologist is unable to accurately examine part of the bowel (usually because of redundant loops) and may suggest further examination with colonoscopy.
Endoscopy has anaesthetic risks.
Both have a very low risk of perforation.