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A Randomized Comparison of Retention Balloon and Standard Tip Rectal Catheters in Preventing Incontinence During Double-Contrast Barium Enema

¹ Radiology Department, Southern General Hospital, 1345 Govan Rd., Glasgow, UK G51 4TF.
² Department of Radiology, Victoria Infirmary, Glasgow, Scotland.
³ Department of Radiology, Southern General Hospital, Glasgow, Scotland.

OBJECTIVE. The objective of this comparison was to determine if retention balloon catheters are more effective than standard tip catheters in preventing barium incontinence during double-contrast barium enemas.

SUBJECTS AND METHODS. A prospective randomized study was conducted over a 1-year period after institutional review board approval. Two hundred twenty-three patients (102 men, 121 women; median age, 68 years; age range, 50-94 years) were randomized to retention balloon or standard tip catheter after giving informed consent. Barium incontinence was graded A (did not lead to examination failure) or B (led to examination failure).

RESULTS. One hundred thirteen patients (51%) were examined with retention balloon catheters and 110 patients (49%) with standard tip catheters. In the retention balloon catheter group, 26 patients (23%) were incontinent (22 [19.5%] grade A, four [3.5%] grade B). In the standard tip catheter group, 31 patients (28%) were incontinent (24 [21.8%] grade A, seven [6.4%] grade B). No significant difference was seen in incontinence rates between the two catheter groups (p = 0.54, chi-square test). Sixteen patients (7.2%) gave a prior history of fecal incontinence. Of these, 15 (94%) developed incontinence, and in seven (44%), grade-B incontinence led to examination failure.

CONCLUSION. Retention balloon catheters have no advantage over standard tip catheters at preventing barium incontinence. Given the possible higher rates of rectal trauma associated with retention balloon catheters, their use may not be justified. A prior history of fecal incontinence is a strong predictor of examination failure.

Keywords: barium • catheter • colonoscopy • enema • fluoroscopy • gastrointestinal radiology

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