[Enteral contrast agents-When, what and how?]

Administration of enteral contrast media (CM) in abdominal computed tomography (CT) is handled inconsistently across Germany.

To present the current recommendations on administration of enteral contrast agents along the guiding questions of when, what and how and to translate them into radiological practice.

Synthesis of indication-based recommendations, CM classes and their technical properties and the practical execution of both routes of administration, based on the recommendations of the German Röntgen Society (DRG), current guidelines, published evidence and institutional practice.

Positive oral CMs are obsolete for most abdominal indications, including acute abdomen, ileus and trauma, and are contraindicated when gastrointestinal bleeding or ischemia is suspected. In cases of suspected perforation, routine oral contrast agents should be omitted and barium sulphate is contraindicated, whereas water-soluble iodinated agents remain an option when a leak has to be specifically demonstrated. Furthermore, enteral contrasting with neutral oral CM remains useful for upper gastrointestinal tumor staging and enterography (preferably magnetic resonance enterography).

An indication-appropriate, guideline-based enteral contrast agent administration reduces unnecessary burden without compromising diagnostic accuracy and should be embedded in standardized workflows.