Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?
OBJECTIVE
To assess replacement of barium enema examination with colonoscopy in relation to age- and sex-related risk factors, place of service, physician specialty, and cost.


METHODS
Between 1985 and 1992, 894,777 insurance claims for barium enema examination and lower gastrointestinal endoscopy were retrospectively examined. Changes in use were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy, two office-based endoscopic procedures, was also examined.


RESULTS
Use of diagnostic colonoscopy increased from 191 to 406 services per 100,000 persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy with lesion removal, from 77 to 202 services. Barium enema examination use declined from 929 to 511 services per 100,000 persons; diagnostic proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in patients aged younger than 40 years were greater than overall increases.


CONCLUSIONS
Colonoscopy has been replacing barium enema examination as the initial colorectal examination since 1985. Increased use of colonoscopy in patients with lower risk of neoplasia suggests that indications have become overly broad.
Karasick
S
S
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Ehrlich
S M
SM
Levin
D C
DC
Harford
R J
RJ
Rosetti
E F
EF
Ricci
J A
JA
Beam
L M
LM
Gigliotti
J V
JV
D000328:Adult; D001466:Barium Sulfate; D003106:Colon / Q000000981:diagnostic imaging*; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D003365:Costs and Cost Analysis; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D012812:Sigmoidoscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends
D001466:Barium Sulfate