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

Jensen, J; Kewenter, J; Asztély, M; Lycke, Gerhard; Wojciechowski, J

doi:10.1002/bjs.1800770311

Cited by 40 publications

(15 citation statements)

References 13 publications

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“…Its sensitivity for Dukes' A and B colorectal cancer ranges from 55% to 85% [9]. Some authors have suggested that this rate can be improved to 96-98% if combined with flexible sigmoidoscopy [5,6]. National Health Service (NHS) Executive guidelines [9], however, acknowledge colonoscopy as the gold standard for the detection of cancer and polyps, with a reported sensitivity of 96.5% and 94%, respectively [11,15].…”

mentioning

confidence: 99%

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Smith

O’Dwyer

2001

Surg Endosc

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Background: Double contrast barium enema (DCBE) is the examination carried out most frequently for investigation of patients with large bowel symptoms. The aim of this study was to compare the sensitivity of DCBE and colonoscopy for the detection of colorectal cancer and neoplastic polyps Ն1 cm. Methods: All patients undergoing DCBE (1389) or colonoscopy (1081) as the primary investigation for large bowel symptoms or for cancer or polyp surveillance in the first 9 months of 1997 at a large teaching hospital were included in this study. At 1 and 2 years following investigation, a computerized search of appropriate diagnosis and procedure codes to detect any missed cancers or polyps was performed for all patients with a normal investigation. Results: Almost 19% of patients in both groups went on to have an additional large bowel investigation over the 2-year period. In the DCBE group, 47 patients (3.5%) had a cancer diagnosed; eight of them had been missed at the primary investigation (sensitivity 83%). In the colonoscopy group, 37 patients (3.4%) had a cancer; one of them had been missed at the primary investigation (sensitivity 97.5%). Neoplastic polyps Ն1 cm were diagnosed in 1.6% of the DCBE group and in 7.7% of the colonoscopy group, with sensitivities of 21.7% and 91.4%, respectively. Nine patients (0.6%) had a false positive diagnosis of cancer in the DCBE group; one had an iatrogenic bowel perforation following flexible sigmoidoscopy. Conclusions: Where adequate facilities and expertise exist, colonoscopy should be the investigation of choice for most patients with large bowel symptoms suggestive of neoplastic disease.Colorectal cancer is the second most common cause of cancer death in the United Kingdom [10]. Despite improvements in surgery and chemotherapy, survival rates over the last 50 years have remained static. One reason for this is that Ն35% of patients are at an advanced stage when first diagnosed [4]. Early detection of colorectal cancer and neoplastic polyps is therefore the key to improvement in this disease, since cure can be effected by surgery and polypectomy may prevent the development of colorectal cancer [16].Double contrast barium enema (DCBE) is the examination carried out most frequently for patients with large bowel symptoms [2]. Its sensitivity for Dukes' A and B colorectal cancer ranges from 55% to 85% [9]. Some authors have suggested that this rate can be improved to 96-98% if combined with flexible sigmoidoscopy [5,6]. National Health Service (NHS) Executive guidelines [9], however, acknowledge colonoscopy as the gold standard for the detection of cancer and polyps, with a reported sensitivity of 96.5% and 94%, respectively [11,15]. In addition, the wider use of colonoscopy has recently been shown to improve the detection rate for early colorectal cancer [7]. The 5-year survival for such lesions is 97.6% [7]; thus, colonoscopy offers real hope for cure of this disease.There have been no large randomized prospective trials comparing the sensitivity of DCBE and colonoscopy for detec...

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confidence: 99%

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Smith

O’Dwyer

2001

Surg Endosc

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“…Flexible sigmoidoscopes reach 70% of bowel cancers and their combination with barium enema increases their sensitivity to 94% and specificity to 99% for the detection of bowel neoplasia 14 Moreover, the ability of a physician to perform this test in most health care settings makes it more accessible. This combined with the relative ease of performing sigmoidoscopies could enable primary care physicians and para-medical staff to perform the procedure after relatively short training.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Flexible Sigmoidoscopy in Symptomatic Population: An Insight to Rapid Access Sigmoidoscopy Clinic

Ahmed¹,

Sadadcharam²,

Lynch³

et al. 2015

Surg Res Open J

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Aim: The study aim was to investigate the correlations between suspicious lower GI symptoms and endoscopic findings in symptomatic population using flexible sigmoidoscopy. Methods:Retrospective review of all rapid access sigmoidoscopy clinic referrals was performed. Clinical, sigmoidoscopy findings and outcome were reviewed. Patients were further monitored for over five years for new cancers.Results: A total of 445 patients met the inclusion criteria. Most patients (87.2%) had a flexible sigmoidoscopy in their first visit; 41.2% had barium enema to investigate proximal bowel. Polyp detection rate was 12.6% with an average distance of 23.1±18.9 cm from the anal verge. Passing mucus (p=0.05) and incontinence (p=0.035) were the only predictive symptoms for polyps. Cancer detection rate was 7%. Almost 93% of cancers were detected with the flexible sigmoidoscope alone with an average distance of 23.1±16.6 cm with majority being advanced as 17.9% had Duke's A. Weight loss (p=0.005), tenesmus (p=0.006) and passing mucus per rectum (p=0.008) were three predictive symptoms on univariate and multivariate analysis. One patient developed a primary cancer 5 years from his index sigmoidoscopy. Substantial savings were achieved using this model of investigation.conclusion: Flexible sigmoidoscopy is easy, safe, sensitive and cost effective investigation for patients with suspicious lower colonic symptoms.

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“…The overall sensitivity for all diagnoses was, in fact, greater for FS/DCBE than colonoscopy in this series due to the greater sensitivity of radiology for diverticular disease. Jensen et al [19], examining patients with positive fecal occult blood tests, reported a sensitivity of 72% for polyps larger than 1 cm for DCBE, 86% for FS, and 94% for a combination of the two procedures. A remarkable figure of 10 of 26 carcinomas were overlooked by DCBE in their series; only two were overlooked by both FS and DCBE.…”

Section: R M Mendelson Et Al: Combined Fs and Dcbementioning

confidence: 97%

A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience

1995

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

Cited by 40 publications

References 13 publications

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Diagnostic Yield of Flexible Sigmoidoscopy in Symptomatic Population: An Insight to Rapid Access Sigmoidoscopy Clinic

A combined flexible sigmoidoscopy and double-contrast barium enema service: initial experience

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