The effect of a formula diet on preparation of the colon for barium enema examination. Impact on health care and costs.

A preliminary study of unselected ambulatory patients having barium enema examinations showed that 31.5% were optimally prepared for evaluation of polypoid mucosal lesions, but 29% had fecal material in the colon that could have obscured the lesions during examination. Although 38 of 42 patients took prescribed cathartics, 84% did not maintain a low-residue diet, as prescribed at this institution. Subsequently, 98 age-matched patients revealed detailed low-residue diet instructions or a formula diet before barium enema examination. Formula preparation resulted in 51% optimal and only 9.5% unacceptable studies compared with 25% optimal and 34% unacceptable examinations in the control group. Caloric intake averaged 700 kcal/day during low-residue diet preparation and was increased almost twofold with formula preparation; improvement was particularly noticeable in the elderly (556 vs 1,286 kcal/day). Prepackaged low-residue defined diets seem acceptable to patients when substituted for a low-residue diet. Bowel cleanliness is greatly enhanced before the barium enema examination, thus improving health care and reducing radiation exposure and costs.