Ms Chancy's letter raises important questions and states some common misconceptions. My answer was based on extensive experience, not only in this country but in Sweden, Holland, England, and Japan. I have studied and performed gastrointestinal examinations in all of these places.As for the relation of the barium enema to the upper gastrointestional examination, I quote from Margulis and Goldberg.1 In many instances the upper gastrointestinal examination is done before the barium enema examination when the large bowel is not obstructed clinically or radiologically. Seemingly, this type of approach is easier on the patient as rigorous preparation of the colon is necessary only once. This sequence also facilitates a meticulous preparation of the colon. It allows inpatients more time for a clear liquid or low residue diet and for administration of cleansing enemas. Residual barium in the colon from the upper gastrointestinal examination is easily seen
Miller RE. Order of Roentgenographic Examinations-Reply. JAMA. 1977;237(25):2721. doi:10.1001/jama.1977.03270520030015
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