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.

• When the small bowel study follows a UGI series, the patient may have 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 through the small intestine.

• 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:
  
  
  • 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.