Clinical Procedures - Barium Follow-Through Indications • Investigation of small bowel pathology, particularly suspected Crohn's disease and strictures. Indications include pain, diarrhea, malabsorption, partial obstruction, anemia • D Always consider alternatives (e.g. MRI, small bowel enema). Contraindications • Absolute: lack of informed consent, complete small bowel obstruction, suspected perforation (a water-soluble contrast may be used instead). Procedure The patient drinks barium and the small bowel is intermittently imaged until the barium has reached the caecum. Usually performed by a radiologist. • The patient is given a mixture of barium to drink • The exact mixture given to the patient varies between centres and between radiologists. Some add Gastrografin® to the barium, which has been shown to reduce transit time. Many add 20mg of metoclopramide to the mixture which enhances gastric emptying • Once the barium has been consumed, the patient is asked into the fluoroscopy room and images are taken of the small bowel with the patient lying supine • Real-time fluoroscopy is employed to assess small bowel motility • Images are taken every 20-30 minutes until the barium has reached the colon • The radiologist may use a 'spoon' or similar radiolucent device to press on the patient's abdomen to separate loops of bowel • Additional images of the terminal ileum are usually obtained, often with the patient supine and many radiologists also acquire an 'overcouch' plain abdominal radiograph with compression applied to the lower abdomen • The time taken depends on the small bowel transit time and, although usually an hour, patients are advised to allow up to 3 hours • After the procedure, the patient may eat and drink as usual but is advised to keep their bowel moving to avoid barium impaction. Risks • Leakage of barium through an unsuspected perforation: • Intraperitoneal barium causes hypovolaemic shock and a 50% mortality. Of those that survive, 30% have adhesions • Barium impaction (causing large bowel obstruction) or barium appendicitis • Medication effects Patient Preparation • Fasting: nil by mouth for 12 hours before the examination • Bowel preparation: laxative (usually Picolax®) taken 12 hours before. Other information • Metoclopramide aids gastric emptying. Extra-pyramidal side effects may occur, especially in young women and there is a risk of acute dystonic reactions such as oculogyric crisis. Contraindicated in patients with Parkinsonism/Parkinson's disease • D A barium study will prevent a CT examination of the same area for a period of time as intestinal barium creates dense streak artefact.
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