title: Colonoscopy can miss diverticula of the left colon identified by barium enema.
abstract: OBJECTIVE
  To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema.
  
  
  METHODS
  A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated.
  
  
  RESULTS
  Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P = 0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01).
  
  
  CONCLUSIONS
  Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001464:Barium; D001466:Barium Sulfate / Q000494:pharmacology*; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D004241:Diverticulum, Colon / Q000175:diagnosis*; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D001464:Barium; D001466:Barium Sulfate
keywords: Barium enema; Colonic diverticular bleeding; Colonic diverticulosis; Colonoscopic diagnosis; Receiver operating characteristic area under the curve