ABSTRACT
Within less than 10 years of the discovery of X rays by Roentgen in 1895, examinations of the colon with opaque contrast material were pioneered and later became part of the routine clinical service that radiology could provide in assessing colonic disease (1,2). Over almost 100 years, the barium enema has undergone many changes and refinements and, in skilled hands, remains at the forefront of radiologic examinations of the large bowel. This technique has evolved from the single-contrast barium enema examination to double-contrast techniques that provide excellent mucosal detail in patients with inflammatory changes, particularly in patients with idiopathic inflammatory bowel disease and in patients at risk for colonic neoplasms. Although the barium enema examination is no longer the most important method of examining patients with suspected inflammatory bowel disease, it does aid in reaching the correct diagnosis in conjunction with the clinical history and examination, laboratory tests, and colonoscopy. The introduction of fiberoptic endoscopic methods has markedly reduced the number of barium enemas performed in the United States. Colonoscopy has the advantage of directly visualizing the colonic mucosa and enables determining the extent of disease, obtaining tissue specimens through biopsies, cauterizing sources of colonic hemorrhage, obliterating small polyps, or decompressing a markedly distended colon. In short, diagnostic as well as therapeutic options are available with colonoscopy.
