Total colonoscopy versus double-contrast barium enema for the detection of intraluminal lesions.

Abstract

Studies have demonstrated that double-contrast barium enema (DCBE) is slowly being superseded by total colonoscopy (TC), as the latter is alleged to have better sensitivity and specificity to detect colorectal pathology. Research has also revealed that DCBE tends to have a higher degree of misdiagnoses when compared to TC. Therefore, physicians are relying more on TC for early detection of polyps, especially when considering their malignant potential. However, the success of TC colonoscopy requires refined technical skills and expensive endoscopic equipment, rendering the procedure less cost effective than DCBE. Thus, DCBE is preferred as a first line colonic examination. DCBE was still hailed as the first line colonic investigation in St Luke's Hospital and constituted some 5% of the daily workload of the radiology department. However, DCBE examinations were being performed without fluoroscopic aid, greatly compromising the diagnostic accuracy of the results. The accuracy of the radiographic examination is highly dependent on equipment, as emphasised in literature and hence the limitation encountered in the radiology department is suggestive of significant number of diagnostic errors. This study revealed that DCBE accounted for 38.5% (20 out of 52) misdiagnoses, which were confirmed by TC examination performed at a later stage. TC was 100% sensitive and specific in its diagnoses suggesting that TC should be employed as first line colonic investigation, especially when considering the technical limitations by which DCBE examinations are being performed.