Non-laxative CT colonography with barium-based faecal tagging: is additional phosphate enema beneficial and well tolerated?

Abstract

OBJECTIVE:

The purpose of this study was to investigate the efficacy and tolerance of an additional phosphate enema prior to non-laxative CT colonography (CTC).

METHODS:

71 patients (mean age 80 years, 28 male, 43 female) underwent non-laxative CTC following 4 oral doses of diluted 2% w/w barium sulphate. Patients were invited to self-administer a phosphate enema 2 h before CTC. An experienced observer graded the volume of retained stool (1 (nil) to 4 (>75% bowel circumference coated)), retained fluid ((1 (nil) to 4 (>50% circumference obscured)), retained stool tagging quality (1 (untagged) to 5 (≥75% to 100%) tagged) and confidence a polyp ≥6 mm could be excluded (yes/no) for each of six colonic segments. Tolerance of the enema was assessed via questionnaire. Data were analysed between those using and not using the enema by Mann-Whitney and Fisher's exact test. 18/71 patients declined the enema.

RESULTS:

There was no reduction in residual stool volume with enema use compared with non-use either overall (mean score 2.6 vs 2.7, p = 0.76) or in the left colon (mean 2.3 vs 2.4, p = 0.47). Overall tagging quality was no different (mean score 4.4 vs 4.3, p = 0.43). There was significantly more retained left colonic fluid post enema (mean score 1.9 vs 1.1, p<0.0001), and diagnostic confidence in excluding polyps was significantly reduced (exclusion not possible in 35% segments vs 21% without enema, p = 0.006). Of 53 patients, 30 (56%) found the enema straightforward to use, but 4 (8%) found it unpleasant.

CONCLUSION:

Phosphate enema use prior to non-laxative CTC leads to greater retained fluid, reducing diagnostic confidence, and is not recommended.

• Authors: W Davis, P Nisbet, C Hare, P Cooke, S A Taylor
• Journal: The British journal of radiology (Br J Radiol) Vol. 84 Issue 998 Pg. 120-5 (Feb 2011) ISSN: 1748-880X [Electronic] England
• PMID: 20959374 (Publication Type: Journal Article)

Chemical References

• Cathartics
• Contrast Media
• Barium Sulfate

Topics

• Aged
• Aged, 80 and over
• Barium Sulfate
• Cathartics (administration & dosage)
• Colonography, Computed Tomographic (methods)
• Contrast Media
• Enema (adverse effects, methods)
• Feces
• Female
• Humans
• Male
• Patient Satisfaction
• Surveys and Questionnaires