GI Radiology > Small Bowel > Imaging Modalities > Follow-Through

Small Bowel Follow-Through (cont.)

The Barium - Its Preparation and Administration

  • The barium sulfate suspension for SBFT must have a density high enough to provide good mucosal coating and avoid flocculation while being transradiant enough to allow detailed evaluation of the mucosa. We use a cup of flat “bubbly barium”, followed by 33% W/V suspension of Sol-O-Pake (E-Z-EM Co., Inc., Westbury, NY). This is prepared by adding 1 cup of barium sulfate to 600 ml of water).
  • The barium suspension is prepared using cold tap water or is chilled overnight in a refrigerator before being administered to the patient. Cooling makes it more palatable. More importantly, cold barium speeds gastric emptying and passes more rapidly through the intestine than does room-temperature barium.
  • A small amount (5 ml) of Gastrografin® (Bracco Diagnostics, Princeton, NJ) is added to each cup of barium. Gastrografin shortens the small bowel transit time, but its exact mechanism of action has not been identified. In the small quantity used, Gastrografin does not significantly dilute the barium or cause deterioration of the mucosal coating.
  • When the small bowel study follows a UGI series, the patient has already been given glucagon IV as part of our routine biphasic-contrast examination. Interestingly, this is no problem because glucagon, after initially paralyzing the bowel (for about 5 minutes), seems to have a rebound effect, speeding transit of the barium considerably.
  • We have the patient ingest a total of 16 - 20 ounces (480 - 600 ml) of barium suspension. The large volume improves gastric emptying and gives more uniform filling of intestinal loops.
  • There are two main benefits to be gained by giving the patient a large volume of chilled barium to which a small amount of Gastrografin has been added:

    1. The diagnostic yield of the small bowel examination is improved. The more uniform filling of long segments of bowel reduces the possibility that a lesion will be passed by the barium between sequential films and go undetected. Better small bowel distention allows easier detection of partial obstruction and tiny lesions.

    2. Small bowel transit time is reduced. Patients become less impatient during the shorter examination. Fewer films are required, thus reducing radiation exposure to the patient and overhead costs. The x-ray room is tied up for a shorter time, allowing greater patient throughput.

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