Is barium enema an adequate diagnostic test for the evaluation of patients with positive fecal occult blood?
BACKGROUND
This study aimed to assess the diagnostic accuracy of double contrast barium enema (DCBE) compared to colonoscopy among Hispanic patients with positive fecal occult blood testing (FOBT). Secondary objectives were to determine: the diagnostic accuracy according to adenoma location, size, and pathologic characteristics; and patient satisfaction with each procedure


METHODS
Cross-sectional study comparing the ac curacy of DCBE and colonoscopy in detecting adenomatous polyps and/or colorectal cancer in patients with positive FOBT. DCBE and a colonoscopy were performed in all patients. Polyps identified during colonoscopy were removed and classified by histology. Tolerability and patient's satisfaction with study procedures was assessed.


RESULTS
Fifty patients were enrolled, mainly men with a mean age of 63 years old. Polyps were fou in 40/50 (80%) patients in colonoscopy, compared to 19/50 (38%) in DCBE. Eighty-four percent of polyps were missed by DCBE. Sensitivity of DCBE was 45% and specificity 90% for all adenomas. Diagnostic accuracy of DCBE was 54% for any size adenomas, and 72% for >10 mm adenomas. Sensitivity increased from right to left colon while specificity decreased. Patients preferred colonoscopy over DCBE.


CONCLUSIONS
This study supports the use of colo noscopy as the gold standard test for the evaluation of positive FOBT and was preferred over DCBE b the patients. Diagnostic accuracy of DCBE was inferior to colonoscopy, for all size polyps and larg adenomas. Compared to colonoscopy, DCBE is a substandard test for colorectal cancer screening and may result in ineffective outcomes.
Ramos
Carlos
C
VA Caribbean Healthcare System, San Juan Puerto Rico.
De Jesús-Caraballo
Joel
J
Toro
Doris H
DH
Ojeda
Algia
A
Martínez-Souss
Jaime
J
Dueño
Maria Isabel
MI
Cruz-Correa
Marcia
M
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D018256:Adenomatous Polyps / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D003111:Colonic Polyps / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004733:Enema; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011859:Radiography; D012680:Sensitivity and Specificity
D003287:Contrast Media; D001466:Barium Sulfate