The purpose of this study was to determine whether small bowel enema or barium follow-through is the most appropriate examination for the routine investigation of patients without documented small bowel disease referred from outpatient sources in our hospital. Two hundred and forty-four patients were prospectively randomised to either small bowel enema (SBE) or barium follow-through (FT). Radiation doses and room times were recorded for the first 95 patients and abnormal results were documented for all. One hundred and twelve FTs and 75 SBEs were performed. The incidence of abnormal results was low overall and comparable in the two groups. There were significantly more abnormalities in the FT group which required further investigations for confirmation. Of those assigned to SBE, 19% were converted to FT due to patient refusal and technical failure. Radiation doses were similar in the two groups, but the time spent occupying the fluoroscopy room was significantly shorter for FT. In our department FT is as effective as SBE in detecting small bowel abnormalities de novo. The radiation dose is similar, but more FTs can be performed per list. Follow-through is also less invasive than SBE and therefore we use this technique as the first line of investigation in this group of patients.