Differential Effects of Laxatives on Barium Sulfate Coating and Image Quality in Double-Contrast Barium Enema

Background: Diagnostic accuracy of double-contrast barium enema (DCBE) depends upon the barium sulfate coating efficiency in the colon. Objective: To evaluate effects of three laxatives on barium sulfate coating efficiency in the large intestine, sigmoid colon, and hepatic flexure in DCBE. Methods. This retrospective study included patients receiving DCBE after pre-procedure cleansing with Dulcolax^® with castor oil (DC), Klean-Prep^® (KP), or Fleet^® . Patients’DCBE images were reviewed. Results: Among 373 cases of DCBE, 151 received DC, 147 received KP, and 75 received Fleet. For DCBE, the optimal extent of barium sulfate residue coated on the wall of the large intestine is less than one-fourth of bowel wall width; the DC group had a higher percentage of less than one-fourth of bowel wall than that of the KP or Fleet group (both p < 0.0167). DC, KP and Fleet have comparable barium sulfate coating efficiency in the sigmoid colon. However, in the hepatic flexure, the DC group had a higher percentage of barium sulfate coating without interruption than that of the KP or Fleet groups (both p < 0.0167). Conclusion: DC has a better barium sulfate coating efficiency in the hepatic flexure compared with KP and Fleet.