title: Relative rates of missed diagnosis for colonoscopy, barium enema, and flexible sigmoidoscopy in 379 patients with colorectal cancer.
abstract: BACKGROUND
  Failures of diagnosis of colorectal cancer by colonoscopy, barium enema, and flexible sigmoidoscopy have been demonstrated using various techniques. A relative assessment of these diagnostic tests for patients with colorectal cancer has not been reported. This study was designed to determine relative rates of failures for these tests when applied to diagnosis of colorectal cancer.
  
  
  METHODS
  We created a database of patients with colorectal cancer diagnosed between 2000 and 2005. Records were reviewed for the results of colonoscopy, barium enema, and flexible sigmoidoscopy in the 3 years prior to diagnosis. An examination that was negative for cancer with no immediate follow-up was defined as a failure of diagnosis, either from inaccurate observation, failure to examine the entire colon, or failure of timely follow-up. The failure rates were compared.
  
  
  RESULTS
  Three hundred seventy-nine patients, who had 421 examinations, were analyzed. The diagnosis of colorectal cancer failed in 60 of 379 patients (16%). These 60 patients had 71 examinations that failed to make the diagnosis: 25 of 282 colonoscopies (9%), 16 of 79 barium enemas (20%), and 30 of 60 flexible sigmoidoscopies (50%). These differences were statistically significant.
  
  
  CONCLUSIONS
  Failure rates for colonoscopy, barium enema, and flexible sigmoidoscopy were 9%, 20%, and 50%.
authors.affiliation: Division of Gastroenterology and Hepatology, Scripps Clinic and The Scripps Research Institute, La Jolla, CA, USA. FrenetC@sutterhealth.org
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Frenette
authors.forename: Williamson B
authors.initials: WB
authors.lastname: Strum
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012812:Sigmoidoscopy
chemical_list: D001466:Barium Sulfate