The double contrast barium enema: why bother?

Despite a wealth of publications extolling the virtues of the double contrast barium enema (DCBE), it is clear that change is only gradual and that in many institutions the single contrast, full column barium enema (BE) is still the routine method of colonic investigation. Much of this may be due to a persistent belief, among the unconverted, that what was good enough yesterday is good enough today. There may also be a belief that an old dog cannot learn new tricks. At least, in many cases, he appears unwilling to try. These beliefs are all too often encouraged by a trickle of articles in the world literature that set out to refute the value of DCBE and thereby add fuel to the dying embers of "conservational" radiology. This article is an attempt to explode some of the persistent fantasies regarding DCBE by reviewing the literature, examining misconceptions, and, hopefully, laying them to rest in their graves--the position that overwhelming worldwide evidence as well as our own experience has assigned for them. I believe that there is little evidence to justify continued use of the barium enema as the standard technic for examining the colon.