Barium Enema (Colon X-ray, barium and air)

What it is

A lower GI series looks at the shape and lining of the large intestine using X-rays rather than a camera. A thin tube is placed in the rectum and barium — a chalky liquid that blocks X-rays — is run in to fill the colon. In the double-contrast version described here, air is then introduced as well, pushing most of the barium off the walls so that only a thin coating remains. That thin film is what makes small surface detail visible; with barium alone, the colon is simply a solid white tube. Glucagon is given to relax the bowel muscle so it stops squeezing while the images are taken. The study also includes plain abdominal films and further images after a delay, which show where the contrast has travelled once time has passed.

Why it is done

• To map the outline of the colon when a colonoscopy cannot be completed, is not tolerated, or is not available
• To look for narrowing, a blockage, or an abnormal connection between the bowel and another structure
• To investigate long-standing bowel symptoms when the question is about the shape and calibre of the colon rather than about tissue
• To check the colon's anatomy before or after certain bowel surgery

What to expect

The colon has to be completely empty, so preparation is similar to a colonoscopy: clear liquids for a day or more beforehand, plus laxatives or enemas as instructed. During the exam a radiologist or technologist watches the contrast move on a live X-ray screen and asks for frequent position changes — onto each side, onto the stomach, back again — because gravity is what moves the barium and air around. Most people feel fullness, pressure, and a strong urge to have a bowel movement; cramping is common. The main run of imaging usually takes half an hour to an hour, and the delayed images add more time. Afterward, barium is passed in the stool over the next day or two, which can look pale or white. There is no sedation, so driving home is generally not a problem.

Questions worth asking

• This code bundles the contrast study, the plain abdominal films, and the delayed images. Is the bowel-prep kit included, or dispensed and billed separately through a pharmacy?
• Is the glucagon billed as a separate drug line item on top of the imaging charge?
• If the study is stopped partway because the prep was inadequate, what is billed — the full study, a partial one, or nothing?
• Some centers offer CT colonography as an alternative. Is that priced differently here, and is it covered by my plan for this indication?