Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.

Irvine, E. Jan; O’Connor, John J.; Frost, Roger; Shorvon, P; Somers, Sat; Stevenson, Giles W.; Hunt, Richard H.

doi:10.1136/gut.29.9.1188

Cited by 89 publications

(25 citation statements)

References 28 publications

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“…The sensitivity of different diagnostic methods, as shown in a prospective study on patients that had presented with rectal bleeding was, in polyps >5 mm, 58% for double contrast barium enemas, 71% for the combined rectal sigmoidoscopy and double-contrast barium enema and 96% for colonoscopy [7]. The limits of colonoscopy are also shown in many other studies: 15% of adenomas >10 mm in diameter are missed by this procedure [8].…”

Section: Rectal Sigmoidoscopymentioning

confidence: 95%

Sensitivity of diagnostic examinations for colorectal polyps

Menardo

2004

Tech Coloproctol

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The removal of adenomatous polyps of the large bowel reduces mortality from colorectal cancer (CRC). Faecal occult blood testing only reveals 20.40% of polyps. The flexible rectosigmoidoscope explores less than half of the large bowel. Its use should always be coupled with faecal occult blood testing which, if positive, requires a total colonoscopy. The sensitivity of double-contrast barium enema for the search of polyps is 35%. Colonoscopy does not reach the caecum in about 10% of cases. It misses 15-20% of polyps with diameter <10 mm and about 6% of polyps with diameter >10 mm. Virtual colonoscopy has substantially the same sensitivity as optical colonoscopy for polyps > or =7 mm in diameter.

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Section: Rectal Sigmoidoscopymentioning

confidence: 95%

Sensitivity of diagnostic examinations for colorectal polyps

Menardo

2004

Tech Coloproctol

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“…The other feature of included studies was the application of a variety of different reference standards. In the detection of colorectal cancer, the most sensitive and specific diagnostic test is colonoscopy, followed by a flexible sigmoidoscopy in combination with a barium enaema (Irvine et al, 1988;Rex et al, 1990;Helfand et al, 1997). In the included studies, a variety of reference standard tests were used with a possibility of work-up bias in some studies as lower-risk patents were subject to less rigorous reference standard tests (Table 2).…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

et al. 2009

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BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009 and PsychINFO (1970 to May 2009 were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3 -15.4%, median: 8.1%). Age X60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00 -3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03 -3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54 -3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30 -10.35), specificity 0.95 (95% CI: 0.93 -0.96), but still only generates a posttest probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines.

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“…Bleeding from hemorrhoids is usually associated with constipation and is initiated by straining at stool or passage of hard stools [12]. Bleeding from hemorrhoids is associated in up to 25% of cases with another pathology localized in the colon and proximal to the hemorrhoids [19]; therefore, further diagnostic follow-up is required.…”

Section: Hemorrhoidsmentioning

confidence: 99%

Genesis and pathophysiology of lower gastrointestinal bleeding

Imdahl

2001

Langenbeck's Archives of Surgery

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The incidence of lower gastrointestinal bleeding (LGB) is estimated to be 20-30 per 100,000 of the adult population at risk, which is clearly correlated with increasing age. The problem of LGB is identification of the bleeding source. LGB stops spontaneously in 80% of cases, but 10% of bleeding sources cannot be identified, and rebleeding occurs in 25%. The quality of LGB--hematochezia, melena, or occult bleeding--may point to the region of the bleeding source, as patient age is correlated with specific pathologies. In many patients, LGB is a leading symptom of a chronic disorder. Most acute peranal bleeding arises from the colon (80%) with colonic diverticula and angiodysplastic lesions as the most frequent reasons. In 5% of cases, LGB is caused by disorders of the small bowel, in most cases due to small-bowel tumors or to Meckel's diverticulum in younger patients. In 15-20%, acute peranal bleeding is caused by lesions in the upper gastrointestinal tract. The intensity of LGB determines the urgency of identification of the bleeding source; however, chronic occult blood loss superimposed by melena may place the patient at risk as early as a patient with hematochezia. Therefore, prompt resuscitation is required in many LGB patients before diagnostic procedures are initiated.

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Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.

Abstract: Traditionally, the investigation of rectal bleeding has been by sigmoidoscopy and barium enema followed by colonoscopy if symptoms persisted despite a negative examination or if the barium enema was technically inadequate.10 Specific indica-

Cited by 89 publications

References 28 publications

Sensitivity of diagnostic examinations for colorectal polyps

Sensitivity of diagnostic examinations for colorectal polyps

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

Genesis and pathophysiology of lower gastrointestinal bleeding

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