Barium enema after flexible sigmoidoscopy: is delay necessary?

There exists a traditional belief that sigmoidoscopy immediately prior to barium enema produces excessive gas and irritability, which subsequently interfere with performance and interpretation of the barium enema study. A survey was initiated to determine whether primary care physicians are generally advised not to perform barium enema examination immediately following proctosigmoidoscopy on the same day. Almost two thirds (56/89) of the physicians indicated that delaying barium enema examination was standard practice in their community. A prospective study was performed on 16 subjects who were examined by a 60-cm flexible sigmoidoscope and then sent for air-contrast barium enema. Ninety-four percent (15/16) of the subjects completed radiologic examinations with no increase in technical difficulty or patient discomfort. One subject was considered to have excessive gas on scout film and was rescheduled for barium enema examination on another day. This preliminary study supports the hypothesis that the majority of patients can sequentially receive both examinations on the same day. For appropriate patients this scheduling would represent a great savings in time, effort, and exposure to bowel preparation protocols.