The diagnostic value of combining flexible sigmoidoscopy and double-contrast barium enema as a one-stage procedure

Results from the consecutive examination of 675 patients using both flexible sigmoidoscopy and a double-contrast x-ray technique were analyzed with special reference to the detection of polyps in the rectum and sigmoid colon. A total of 193 polyps were found. Histological examination of 93 polyps revealed that half of those less than 5 mm in diameter and 93.3% of those more than 6 mm in diameter were adenomas. The x-ray examination failed to detect 44% of the proven adenomas smaller than 5 mm, 35.3% of those 6-10 mm in size, and 16.7% of those larger than 11 mm in diameter. These rates were significantly higher than those of flexible sigmoidoscopy, which had corresponding miss rates of 8, 11.2, and 0%, respectively. The double-contrast barium enema (DCBE) failed to detect every second polyp in the rectosigmoid. Every second polyp in the same region proved to be adenoma. The DCBE combined with flexible sigmoidoscopy gives the most reliable and precise diagnosis of various disorders of the rectum and sigmoid colon.