To the Editor:—I read the article "Inadequate Barium Enemas in Hospitalized Elderly Patients: Incidence and Risk Factors" with interest. Of 140 patients over 65 years of age, the authors cite a 31% incidence of inadequate barium enemas in patients who were febrile, cachectic, and confused. However, 97 or 25% of the adequate barium enemas revealed clinically significant abnormalities, while in the 43 examinations held to be inadequate, 3 clinically significant diagnoses were rendered. Colonoscopy performed on 9 patients with inadequate barium examinations revealed an abnormality (polyp) in only 1 subject.
Many incomplete barium enema studies may be salvaged despite an inability to retain barium by proceeding to an upper gastrointestinal tract series, if no contraindications exist, with subsequent delayed films to visualize the ileocecal region and the remaining colon, if necessary. This previously described technique2 is cur(Continued on p 2415.) (Continued from p 2412.) rently modified by using
POCHACZEVSKY R. Inadequate Barium Enemas in Elderly Patients. Arch Intern Med. 1990;150(11):2412-2415. doi:10.1001/archinte.1990.00390220140037