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Double-contrast barium enema


  • Done without sedation
  • Very low risk
  • Less expensive than a colonoscopy
  • Identifies lesions in the entire colon
  • Accurate for finding abnormalities, such as narrowed areas or pockets or sacs, in the intestinal wall.
  • Can find cancer in earliest stage, when most treatable
  • Slight risk of perforation
  • Less expensive option to colonoscopy


  • Polyps cannot be removed during the procedure — you will need to get a colonoscopy if abnormalities are spotted on X-rays
  • Requires laxative preparation
  • Some may find the test uncomfortable
  • Availability is decreasing; usually only for those who cannot undergo colonoscopy
  • Uses X-ray radiation

What can I expect for a bill?

Average cost before insurance: $250 – $500

Will my insurance cover it?

Many plans cover it, so check with your policy holder. Medicare varies, as sometimes this procedure may be substituted for a colonoscopy. Check with Medicare.

The facts

The Double-Contrast Barium Enema (also called DCBE or barium enema) uses X-rays to find abnormal growths in the colon. Barium, a silver-white metallic compound, is used to outline the colon and rectum on the X-ray. Air is then passed through the same tube to further enhance the X-ray.

Barium enemas are low risk and often less expensive than a colonoscopy. They are commonly used to diagnose colorectal cancer and inflammatory disease. But it doesn’t end there: barium enemas also help detect polyps, diverticulum (a pouch pushing out from the colon) and structural changes in the large intestine.

The prep

In order to conduct the most accurate barium enema test, you will need to follow a prescribed diet and bowel prep before the test. Like a colonoscopy, this prep commonly includes restricted intake of dairy products and a liquid diet for 24 hours beforehand. You’ll also need to drink lots of water or clear liquids leading up to your barium enema.

The procedure

To begin a barium enema, your doctor will have you lie on your back on a tilting table so you can easily have X-rays taken of your abdomen. Then, you’ll be asked to lie on your side. At that point, a well-lubricated rectal tube is inserted through the anus. This tube allows your doctor to slowly administer the barium into the rectum and colon. Your doctor may also choose to use a rectal balloon to help retain the barium.

As the barium fills the intestine, X-rays of the abdomen are taken to distinguish significant findings and help detect abnormal growths. Your doctor will take X-rays from several different angles to see your whole colon. He or she may also ask you to move around on the table or turn over to help spread the barium sulfate through your colon and provide additional views. The process lasts for about 30 to 45 minutes.

The big 'what if…'

If your doctor sees something suspicious during this test, he or she may order a follow-up colorectal cancer screening test, such as a colonoscopy.

After the test

While a barium enema is considered a safe screening test and is used on a routine basis, it can cause complications in certain people. Please keep these indications in mind before a barium enema is performed:

Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon or a presumed perforation in the intestine should not undergo a barium enema.
The test can be cautiously performed if the patient has a blocked intestine, ulcerative colitis, diverticulitis or severe bloody diarrhea.

Rare complications may include perforation of the colon, water intoxication, barium granulomas (inflamed nodules) and allergic reaction.

How often (if not high risk)

Every 5 to 10 years starting at age 45.

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