Comparison of Oral Sodium Phosphate and Warm Water Enema for Bowel Preparation Prior to Double-Contrast Barium Enema: A Prospective Randomized Clinical Trial
Article Sidebar
Main Article Content
Abstract
Background: Double-contrast barium enema (BE) is a common radiological study for colonic evaluation. Adequate colonic preparation is essential for the accurate interpretation and could be done by either enema or oral laxatives. Oral sodium phosphate (OSP) is an interesting laxative agent and well known for cleaning bowel prior to colonoscopy. It has not been used for BE in
Srisangworn Sukhothai Hospital.
Objective: To compare quality of bowel preparation for BE between 3 methods; OSP, warm water enema, and OSP combined with enema.
Material and Method: A prospective randomized clinical trial was conducted on 45 patients who underwent BE at Srisangworn Sukhothai Hospital between February and August 2008. The patients were equally allocated into 3 groups of bowel preparation methods by randomization; group 1 OSP , group 2 warm water enema and group 3 OSP combined with warm water enema.
Demographic data, amount of OSP administration, number of enema and bowel evacuation were recorded. The level of bowel cleanness and quality of interpreted films were evaluated by one radiologist using 5-leveled grading system for colon cleansing. One way ANOVA and exact probability test were used for statistical analysis.
Results: Eighteen patients were male and 27 were female. The mean age was 52 years (range, 24-74). The quality of interpreted films and demographic data were not significantly different between 3 groups, except the mean age and waist circumference were higher in group 2 (p=0.033 and 0.011 respectively). OSP alone or combined with enema caused more frequency of bowel
evacuation than warm water enema alone (p<0.001). No significant difference of colonic cleanness among 3 groups was demonstrated (p=0.108) when using 5-leveled grading system. Re-classified evaluation into 2 classes, acceptable (grade 3-4) and unacceptable (grade0-2), resulted less favorable cleanness in warm water enema alone group than the others (p=0.02). Subgroup analysis between OSP alone and OSP combined with enema found no significant difference (p=0.651).
Conclusion: OSP preparation, either using alone or combined with warm water enema, did not provide significant difference for bowel cleaning quality prior to barium enema. Both methods resulted in more favorable cleanness than warm water enema alone. OSP was the appropriate choice in routine bowel preparation for barium enema.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
References
Steine S. Which hurts the most ? a comparison of pain rating during double-contrast barium enema examination and colonoscopy. Radiology 1994;191:99-101.
Patton DD, Woolfenden JM. A utility-based model for comparing the cost-effectiveness of diagnostic studies. Invest Radiol 1989;24:263-71.
MacCarty RL. Coloractal cancer: the case for barium enema. Mayo Clin Proc 1992;67:253-7.
Eddy DM. Screening for colorectal cancer. Ann Int Med 1991;113:373-84.
Miller RE. The cleansing enema. Radiology 1975;117:483-5.
Toledo TK, Dipalma JA. Review article: colon cleansing preparation for gastrointestinal procedures. Aliment Pharmacol Ther 2001;15:605-11.
Brown AR, DiPalma JA. Bowel preparation for gastrointestinal procedures. Curr Gastroenterol
Rep 2004;6:395-401.
O’Donovan AN, Somers S, Farrow R, Mernagh J, Rawlinson J, Stevenson GW. A prospective blinded randomized trial comparing oral sodium phosphate and polyethylene glycol solutions for bowel preparation prior to barium enema. Clin Radiol 1997;52:791-3.
Dodds WJ, Scanlon GT, Shaw DK, Stewart ET, Youker JE, Matter GE. An evaluation of colon cleansing regimens.
Am J Roentgenol 1977;128:57-9.
Gelfand DW, Chen MYM, Ott DJ. Preparing the colon for the barium enema examination. Radiology 1991;178:609-13.
Hughes K, Mann S, Cooke MBD, James WB. A new oral bowel evacuant (Picolax) for colon cleansing. Clin Radiol 1983;34:75-7.
Hawes RH, Lehman GA, Brunelle RL, Miller RE. Comparative efficacy of colon-cleansing methods: standard preparation vs Colimmac lavage. Am J Roentgenol 1984;142:309-10.
Kolts BE, Lyles WE, Achem SR, Burton L, Geller AJ, Macmath T. A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation. Am J Gastroenterol 1993;
:1218-23.
Mathus-vliegen EMH, Kemble UM. A prospective randomized blinded comparison of sodium phosphate and polyethylene glycol-electrolyte solution for safe bowel cleansing. Aliment Pharmacol Ther 2006;23:543-52.
Forster JA, Thomas WM. Patient preferences and side effects experienced with oral bowel preparations versus self-administered phosphate enema. Ann R Coll Surg Engl 2003;85:185-6.
Gutirrez SM, Garca UM, Amado JA, González MJ, Riancho JA. Electrolyte disorders following colonic cleansing for imaging studies. Med Clin (Barc) 2006;126:161-4.
Yichayaou B, Josef G, Avraham W, Boris G, Uzi G, Avry C. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med 2003;163:803-8.