Barium enema in the treatment algorithm of lower gastrointestinal tract bleeding.

*Financial sponsoring – none Contrast barium enema is a 60-200% solution of barium sulphate, administered rectally. It is used not only in the diagnostics of colorectal diseases, but also as a therapeutic option in case of intussusception or treatment of lower gastrointestinal tract bleeding. The latter indication raises most controversies amongst surgeons. Opponents argue that 7080% of cases of lower gastrointestinal bleeding resolve spontaneously, barium enema hinders further diagnostics (colonoscopy, abdominal CT), and the potential complications (perforation with chemical peritonitis, intravasation possibly leading to thromboembolic complications or sudden cardiac arrest) might significantly deteriorate the patients’ condition (1). On the other hand, the supporters of the method cited numerous publications showing that the percentage of spontaneous bleeding control by means of conservative therapy is much lower, amounting to 30%, significant complications associated with the enema are rarely observed (perforation) (0.04% of cases), and the method may prevent the patient from extensive surgery (2, 3). The aim of this study was to review literature data in evaluating the usefulness of barium enema in the treatment algorithm of lower gastrointestinal tract bleeding, based on evidence-based medicine. The following databases were searchedPubmed, Ovid Medline, Science Direct, and Springer using the key words: “lower gastrointestinal bleeding, “contrast barium enema”, “gastrointestinal bleeding control”, and “barium enema”. The study included all methodologically correct investigations concerning the above-mentioned problem. The first publication concerning the usefulness of barium enema in the treatment of lower gastrointestinal bleeding dates back to 1970. Adams et al. observed bleeding control in 26 of 28 patients, and lack of hemostasis in the remaining two patients was an indication for surgical intervention. The only observed infusion-related complication was rupture of the rectal mucosa (4). The following publication of the author (1974) showed an increased number of patients to 49 subjects, with bleeding control after barium enema observed in 47. The efficacy of the method amounted to 96% (5). Koperna et al. published the only available prospective study concerning therapeutic barium enema in the management of lower gastrointestinal bleeding. The study group comprised 102 patients with bleeding as a complication of diverticular disease. Hemostasis was obtained in 84% (53 of 63) of patients. The authors concluded that barium enema has a higher efficacy in the treatment of bleeding, as compared to conservative therapy. Recurrence of bleeding in case of conservative therapy was observed in 43.3% of patients, as