Bowel preparation for the double-contrast barium enema: How to maintain coating with cleansing?

AIM: Poor mucosal coating, due to excess of fluid in the colon lumen, is a problem when the oral lavage method (4 litres of an iso-osmotic saline solu tion containing polyethylene glycol) is used as a preparation for double-co ntrast barium enema. Our aim was to assess the value of prior administratio n of sennosides to obtain a clean colon with a reduced volume of polyethyle ne glycol (PEG)saline solution, but maintaining good mucosal coating. MATERIALS AND METHODS: After a 2-day low-residue diet, three different oral preparations were compared: (i) 4 litres of a PEG-saline solution (SELG(R) ) and 15 mg of bisacodyl (116 patients, SELG-4 group); (ii) 156 mg of senno sides, 15 g of magnesium sulphate, and 2 litres of water (116 patients, Sen nMg group); (iii) 156 mg of sennosides and 2 litres of SELG (116 patients, SennSELG group). Compliance, complaints, cleansing, mucosal coating, and fl uid retention were evaluated, RESULTS: Compliance was > 91% in every group, A higher percentage of mild n ausea was observed in SELG-4 group, of mild abdominal cramping in SennMg gr oup, of substantial abdominal cramping in SennSELG group (P < 0.02). Cleans ing was better in SennSELG than in both the SELG-4 (P = 0.0003) and SennMg (P = 0.0353) group. Mucosal coating was better in SennMg than both SELG-4 ( P = 0.0034) and SennSELG (P < 0.0001) group. There was more residual fluid in the SennSELG group than both in SELG-4 (P = 0.0029) and SennMg (P = 0.00 59) group. CONCLUSION: For colon cleansing, the combination of sennosides and PEG-sali ne solution was better than either the 4 litre PEG protocol or the combinat ion of sennosides and magnesium sulphate. For mucosal coating, the protocol combining sennosides and magnesium sulphate was more effective than either protocols using the PEG-saline solution. This may be due to the interactio n of residual magnesium ions in the colon lumen with the barium suspension.