[Enteral contrast media-when, what, and how?]

Enteral contrast media (CM) administration in abdominal computed tomography (CT) is handled inconsistently across Germany.

To present the current recommendations on enteral CM administration based on the key 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 German Radiological Society (DRG) recommendations, current guidelines, published evidence, and institutional practice.

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

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