Assessment of the double contrast barium meal: method and application

Dose reduction of hyoscine-N-butylbromide for double-contrast barium meal examinations--a prospective randomized study

A search of the literature suggests that the conventional 20 mg dose of intravenous hyoscine-N-butylbromide (HBB) for smooth muscle relaxation in double-contrast barium meal (DCBM) studies is largely empirical. This study analysed the merits of three different doses (5 mg, 10 mg, 20 mg) in the performance of routine DCBMs. One hundred and twenty DCBM examinations were prospectively and randomly allocated to receive one of three doses. Three parameters were measured for each examination: gastroduodenal distension, delay in gastric emptying and gastric antrum overlapping with barium-filled duodenal loops. Almost half the examinations using 5 mg produced undesirable duodenal-gastric overlay. Unacceptable early flooding of the duodenal bulb with barium was seen mostly with doses of 5 mg and 10 mg. Overall, the best results were obtained with 20 mg. The continued use of 20 mg HBB in routine DCBMs is recommended.

Morning or afternoon barium meal? Diurnal variation and the effectiveness of gastric mucosal coating during double-contrast studies

The radiographs of 60 patients having double-contrast barium meal examinations were analysed by a linear analogue technique to assess variation in the quality of mucosal coating between morning and afternoon studies. No significant difference (P greater than 0.5) was found between morning and afternoon gastric mucosal coating. Factors that could in theory contribute to a diurnal variation are discussed. We conclude that afternoon DCBMs can be confidently booked and performed, in the knowledge that their diagnostic quality is not impaired.

The minimum effective dose of glucagon in upper gastrointestinal radiography

The effect of small intravenous doses (0.025 and 0.05 mg) of glucagon was evaluated in 22 patients. All 12 patients given 0.05 mg demonstrated by hypotonicity of the stomach and duodenum at 1 min and beginning return of peristalsis at 2 1/2 min. Subsequently, 100 patients with radiographically normal upper gastrointestinal examinations who received 0.05 mg of glucagon intravenously were compared to 100 patients with normal examinations without it. Comparison was made to determine the effect of glucagon on gastric mucosal coating and distention of the stomach and duodenum. In all areas of the stomach, mucosal coating was significantly improved in the glucagon group. There was also increased distention of the distal antrum, duodenal bulb, and duodenal loop. No adverse effects were reported. Because of the short duration of action of glucagon, the examination needs to be coordinated and done rapidly. The routine use of a small dose of glucagon increased the performance time slightly with small additional cost but was compensated for by the increased diagnostic quality of the examination.

A comparison of barium sulphate preparations used for the double contrast barium meal

Radiologists' opinions of the properties of six barium suspensions with their recommended gas-producing agents designed for upper gastrointestinal use were assessed, using a linear analogue scale. Five radiologists independently assessed mucosal coating of stomach and duodenum, areae gastricae, gaseous distension and bubble formation in a total of 258 patient examinations. Preparation 1 (EZHD) was judged to give best overall results, coating stomach and duodenum particularly well. Preparation 2 (X-Opaque) gave good distension and also coated mucosa fairly well, as did preparations 3 and 4 (Medebar XAC and Field 2C). The latter two preparations produced good distension at the expense of bubble formation. Preparations 5 and 6 (Micropaque DC and Baritop G) were judged, by comparison, to have performed poorly as regards mucosal coating. None of the preparations delineated areae gastricae well, even in the presence of good, bubble-free gastric distension.

A comparison of four methods of bowel preparation for barium enema

A retrospective trial was carried out comparing four methods of bowel preparation on a randomly selected group of 503 patients. The methods of bowel preparations were: (1) X-prep alone, (2) X-prep plus three-day diet, (3) X-prep plus high colonic washout, (4) X-prep plus high colonic washout and three day diet. Faecal content was assessed independently by three radiologists and recorded on a linear analogue scale. Statistically significant differences were shown between the results obtained by each method; 97% of patients prepared by method (4) were acceptable, 89% of method (2), 83% of method (3) and 71% of method (1). It was also found that in-patients exposed to the same method of preparation as out-patients showed inferior bowel cleanliness although not to a statistically significant degree.

Barium sulphate preparations for use in double contrast examination of the upper gastrointestinal tract

Physical properties relevant to upper gastrointestinal radiology have been compared for five barium sulphate preparations and related to radiographic results. Evaluation of particles (size and stability) and whole suspension (dispersibility and fluidity) resulted in ranking of the preparations generally in accord with that based on radiological experience in double contrast examinations of the stomach. Experiments with extirpated pig stomach revealed a tendency for large particles in a low viscosity barium sulphate suspension to settle in mucosal grooves. This is believed to contribute to good radiographic definition of both the areae gastricae and small lesions. Particle size is therefore important and susceptibility to flocculation, a possible cause of random change in size during use, was assessed by measuring particle electrophoretic mobility under varying conditions; quantitative differences in suspension flow and dispersibility were also demonstrated. Fluidity and dispersibility together with rapid sedimentation of suitably sized particles resistant to flocculation underlie the successful use of low viscosity high density barium sulphate suspensions.

A new method for studying barium sulphate contrast media in vitro. Some factors contributing to the visualization of areae gastricae

We have developed a new method for quantifying the adsorption of contrast media in vitro onto the gastric mucosa, and the visibility of the areae gastricae objectively, using the pig's stomach. The method simulates the situation in vivo, it has a small intra-assay variability, and it can easily be repeated. We have compared the adsorption of the contrast media manufactured for double contrast examination, the visualization of areae gastricae and the influence of the density of the medium on these factors. It is important to obtain a thin layer of the medium on the surface of the mucosa, and this layer must be dense enough to absorb radiation well. These conditions were fulfilled by only one of the examined media.

Metoclopramide in double contrast barium meals

A prospective controlled trial was carried out to evaluate the usefulness of the administration of Metoclopramide (Primperan) prior to double contrast barium meal examinations. The results indicated that this did not significantly alter the quality of the examination.

Double contrast examination of the stomach compared with endoscopy

The results of the double examination of the stomach in a series of 102 patients were compared with the findings at endoscopy. Nasogastric intubation was used to introduce the air into the stomach. Hypotonia was achieved mainly with glucagon. The radiologic error rate was 10 per cent, consisting of 7 per cent false negative and 3 per cent false positive findings. The diagnostic advantages of the double contrast technique over those of the conventional barium examination are discussed.