Barium Enema and Endoscopy for the Detection of Colorectal Neoplasia: Sensitivity, Specificity, Complications and its Determinants

doi:10.1053/crad.2000.0672

Clinical Radiology

Volume 56, Issue 5, May 2001, Pages 401-409

https://doi.org/10.1053/crad.2000.0672 Get rights and content

Abstract

AIM: To analyse sensitivity, specificity and complication rate of endoscopy, and barium enema for the detection of colorectal neoplasia. MATERIALS AND METHODS: A MEDLINE search was performed (1980–2000) directed at the endoscopic and radiologic literature on barium enema. Articles were selected based on the type of study, availability of sensitivity and specificity values in sizeable patient groups, and reports on complications. Sixty articles were included in the analysis. RESULTS: Endoscopy proved to have superior sensitivity for polyps in patients at high-risk for colorectal neoplasia. The role of endoscopy and radiology in average-risk screening populations is not known. Sensitivity and specificity rates ranged widely, probably due to bias. For the detection of small polyps endoscopy has superior performance, whereas sensitivity is similar for endoscopy and barium enema for the detection of larger (>1 cm) polyps and tumours. Overall, endoscopy is associated with a higher complication rate. CONCLUSION: Endoscopy is the preferred detection method in high-risk patients. The role of endoscopy and radiology in a screening setting requires evaluation. This review provides the test characteristics of endoscopy and radiology which are relevant for a cost-effectiveness analysis. Double-contrast barium enema may play an important role for screening purposes, owing to its good sensitivity for detecting larger (>1 cm) polyps and its lack of major complications. de Zwart, I. M.et al. (2001). Clinical Radiology56, 401–409.

References (112)

R Midgley et al.
Colorectal cancer [see comments]
Lancet
(1999)
NJ Spencer et al.
Colorectal polyps: a correlation of radiological and pathological findings
Clin Radiol
(1988)
DA Lieberman
Cost-effectiveness model for colon cancer screening
Gastroenterology
(1995)
DK Rex et al.
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies [see comments]
Gastroenterology
(1997)
JH Haseman et al.
Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals [see comments]
Gastrointest Endosc
(1997)
JB Marshall et al.
Photodocumentation of total colonoscopy: how successful are endoscopists? Do reviewers agree?
Gastrointest Endosc
(1996)
JD Waye et al.
Total colonoscopy: is it always possible?
Gastrointest Endosc
(1991)
SC Kadakia et al.
Prevalence of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy
Gastrointest Endosc
(1996)
I Beggs et al.
Diagnosis of carcinoma of the colon by barium enema
Clin Radiol
(1983)
P Durdey et al.
Colonoscopy or barium enema as initial investigation of colonic disease
Lancet
(1987)

DK Rex et al.

Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice [see comments]

Gastroenterology

(1997)

A Blakeborough et al.

Complications of barium enema examinations: a survey of UK Consultant Radiologists 1992 to 1994

Clin Radiol

(1997)

GR Sissons et al.

Severe urticarial reaction to rubber: complication of a barium enema [letter]

Clin Radiol

(1991)

SR Harries et al.

Hydronephrosis: a rare late complication of barium enema

Clin Radiol

(1999)

WK Chong et al.

Case report: pneumoperitoneum, omental emphysema and intramural barium perforation following double contrast barium enema

Clin Radiol

(1987)

SJ Winawer et al.

Colorectal cancer screening: clinical guidelines and rationale [see comments] [published errata appear inGastroenterology 1997;112:1060 and 1998;114:625]

Gastroenterology

(1997)

R Vender et al.

Appendicitis as a complication of colonoscopy

Gastrointest Endosc

(1995)

RT Greenlee et al.

Cancer statistics 2000

Cancer J Clin

(2000)

P Peltomaki et al.

Genetic mapping of a locus predisposing to human colorectal cancer

Science

(1993)

GW Stevenson

Colorectal cancer imaging: a challenge for radiologists

Radiology

(2000)

GS Gazelle et al.

Screening for colorectal cancer

Radiology

(2000)

RG Norfleet et al.

Adenomatous and hyperplastic polyps cannot be reliably distinguished by their appearance through the fiberoptic sigmoidoscope

Dig Dis Sci

(1988)

SJ Winawer et al.

Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup [see comments]

N Engl J Med

(1993)

SJ Winawer et al.

A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group [see comments]

N Engl J Med

(2000)

H Ahsan et al.

Family history of colorectal adenomatous polyps and increased risk for colorectal cancer

Ann Intern Med

(1998)

AI Neugut et al.

Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding [see comments]

Am J Gastroenterol

(1993)

J Jensen et al.

Diagnostic accuracy of double-contrast enema and rectosigmoidoscopy in connection with faecal occult blood testing for the detection of rectosigmoid neoplasms

Br J Surg

(1986)

DK Rex et al.

Sensitivity of double-contrast barium study for left-colon polyps

Radiology

(1986)

RF Thoeni et al.

Detection of rectal and rectosigmoid lesions by double-contrast barium enema examination and sigmoidoscopy. Accuracy of technique and efficacy of standard overhead views

Radiology

(1982)

J Jensen et al.

Double contrast barium enema and flexible rectosigmoidoscopy: a reliable diagnostic combination for detection of colorectal neoplasm

Br J Surg

(1990)

NT Brewster et al.

Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation

Br J Surg

(1994)

Y Saito et al.

The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure

Gastrointest Radiol

(1989)

EJ Irvine et al.

Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding [see comments]

Gut

(1988)

AP Brady et al.

Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem [see comments]

Radiology

(1994)

S Bolin et al.

Carcinoma of the colon and rectum. Tumors missed by radiologic examination in 61 patients

Cancer

(1988)

FM Kelvin et al.

Colorectal carcinoma missed on double contrast barium enema study: a problem in perception

Am J Roentgenol

(1981)

JB Markus et al.

Double-contrast barium enema studies: effect of multiple reading on perception error

Radiology

(1990)

N Anderson et al.

Colonoscopically detected colorectal cancer missed on barium enema

Gastrointest Radiol

(1991)

DM Eddy

Screening for colorectal cancer [see comments]

Ann Intern Med

(1990)

E Strom et al.

Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway

Radiology

(1999)

PA Farrands et al.

Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon

Dis Colon Rectum

(1983)

LJ Hixson et al.

Prospective study of the frequency and size distribution of polyps missed by colonoscopy

J Natl Cancer Inst

(1990)

SJ Winawer et al.

Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup [see comments]

N Engl J Med

(1993)

SN Glick et al.

Large colonic neoplasms missed by endoscopy

Am J Roentgenol

(1989)

A Cairns et al.

Flat adenomas

Br J Surg

(1999)

JM Church

Complete colonoscopy: how often? And if not, why not?

Am J Gastroenterol

(1994)

FM Kelvin et al.

Colorectal carcinoma detected initially with barium enema examination: site distribution and implications

Radiology

(1988)

DA Lieberman et al.

Use of colonoscopy to screen asymptomatic adults for colorectal cancer

N Engl J Med

(2000)

GW Stevenson

Radiology and endoscopy in the pretreatment diagnostic management of colorectal cancer

Cancer

(1993)

Y Cheong et al.

Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination

Abdom Imag

(1998)

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^f1: Author for correspondence and guarantor of study: Ingrid M. de Zwart, Leiden University Medical Center, Department of Radiology, C2-S, Albinusdreef 2, NL-2333 ZA Leiden, The Netherlands. Fax: +31(0)71-5248256; E-mail: [email protected]

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Regular ArticleBarium Enema and Endoscopy for the Detection of Colorectal Neoplasia: Sensitivity, Specificity, Complications and its Determinants

Abstract

Lancet

Clin Radiol

Gastroenterology

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Clin Radiol

Lancet

Gastroenterology

Clin Radiol

Clin Radiol

Clin Radiol

Clin Radiol

Gastroenterology

Gastrointest Endosc

Cancer statistics 2000

Cancer J Clin

Genetic mapping of a locus predisposing to human colorectal cancer

Science

Colorectal cancer imaging: a challenge for radiologists

Radiology

Screening for colorectal cancer

Radiology

Adenomatous and hyperplastic polyps cannot be reliably distinguished by their appearance through the fiberoptic sigmoidoscope

Dig Dis Sci

Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup [see comments]

N Engl J Med

A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group [see comments]

N Engl J Med

Family history of colorectal adenomatous polyps and increased risk for colorectal cancer

Ann Intern Med

Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding [see comments]

Am J Gastroenterol

Diagnostic accuracy of double-contrast enema and rectosigmoidoscopy in connection with faecal occult blood testing for the detection of rectosigmoid neoplasms

Br J Surg

Sensitivity of double-contrast barium study for left-colon polyps

Radiology

Detection of rectal and rectosigmoid lesions by double-contrast barium enema examination and sigmoidoscopy. Accuracy of technique and efficacy of standard overhead views

Radiology

Double contrast barium enema and flexible rectosigmoidoscopy: a reliable diagnostic combination for detection of colorectal neoplasm

Br J Surg

Double-contrast barium enema and flexible sigmoidoscopy for routine colonic investigation

Br J Surg

The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure

Gastrointest Radiol

Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding [see comments]

Gut

Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem [see comments]

Radiology

Carcinoma of the colon and rectum. Tumors missed by radiologic examination in 61 patients

Cancer

Colorectal carcinoma missed on double contrast barium enema study: a problem in perception

Am J Roentgenol

Double-contrast barium enema studies: effect of multiple reading on perception error

Radiology

Colonoscopically detected colorectal cancer missed on barium enema

Gastrointest Radiol

Screening for colorectal cancer [see comments]

Ann Intern Med

Colon cancer at barium enema examination and colonoscopy: a study from the county of Hordaland, Norway

Radiology

Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon

Dis Colon Rectum

Prospective study of the frequency and size distribution of polyps missed by colonoscopy

J Natl Cancer Inst

Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup [see comments]

N Engl J Med

Large colonic neoplasms missed by endoscopy

Am J Roentgenol

Flat adenomas

Br J Surg

Complete colonoscopy: how often? And if not, why not?

Am J Gastroenterol

Colorectal carcinoma detected initially with barium enema examination: site distribution and implications

Radiology

Use of colonoscopy to screen asymptomatic adults for colorectal cancer

Regular Article
Barium Enema and Endoscopy for the Detection of Colorectal Neoplasia: Sensitivity, Specificity, Complications and its Determinants