Indications for a barium enema

What are indications for either single- or double-contrast techniques of a barium enema examination?

  • • Single contrast: for fistula or sinus tract evaluation, anastomotic integrity prior to ileostomy closure, and obstruction (predominantly colonic volvulus)
  • • Double contrast: for colorectal cancer and colitis

There has been a substantial decline in the use of double-contrast barium enema as a screening tool for colorectal cancer detection, as it has been largely replaced in favor of optical or virtual colonoscopy. Although once touted as an effective test in this manner because of its relative low cost, minimal risk, and ability to evaluate the entirety of the colon, double-contrast barium enema has been shown to be less sensitive for polyp detection compared with optical colonoscopy, which has emerged as the accepted gold standard.


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