Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography.
OBJECTIVE
The purpose of our study was to perform a meta-analysis comparing the performance of double-contrast barium enema (DCBE) with CT colonography (CTC) for the detection of colorectal polyps > or = 6 mm using endoscopy as the gold standard.


METHODS
Prospective DCBE and CTC studies were identified. Percentages of polyps and of patients with polyps > or = 10 mm and 6-9 mm were abstracted. The performance of DCBE versus CTC was determined by separately evaluating each technique's performance versus that of endoscopy, and contrasting the techniques. The I-squared statistic and Fisher's exact test were used for heterogeneity, the Cochran-Mantel-Haenszel and the Kruskal-Wallis tests for correlation, and the A(z) test for comparing pooled weighted estimates of performance.


RESULTS
Eleven studies of DCBE (5,995 patients, 1,548 polyps) and 30 studies of CTC (6,573 patients, 2,348 polyps) fulfilled inclusion criteria. For polyps > or = 10 mm, a 0.121-per-patient sensitivity difference favored CTC (p < 0.0001; DCBE, 0.702 [95% CI, 0.687-0.715]; CTC, 0.823 [0.809-0.836]). For polyps > or = 10 mm, a 0.031-per-polyp sensitivity difference favored CTC (p < 0.0001; DCBE, 0.715 [0.703-0.726]; CTC, 0.746 [0.735-0.757]). For polyps > or = 10 mm, a specificity difference of 0.104 favored CTC (p = 0.001; DCBE, 0.850 [0.847-0.855]; CTC, 0.954 [0.952-0.955]). DCBE was also significantly less sensitive for 6- to 9-mm polyps (p < 0.001).


CONCLUSIONS
DCBE has statistically lower sensitivity and specificity than CTC for detecting colorectal polyps > or = 6 mm.
Sosna
Jacob
J
Department of Radiology, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel. jacobs@hadassah.org.il
Sella
Tamar
T
Sy
Oumar
O
Lavin
Philip T
PT
Eliahou
Ruth
R
Fraifeld
Shifra
S
Libson
Eugene
E
D001466:Barium Sulfate / Q000008:administration & dosage*; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D023881:Colonography, Computed Tomographic / Q000706:statistics & numerical data*; D004733:Enema; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000000981:diagnostic imaging / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D001466:Barium Sulfate