Reliability of barium enema in detecting colonic neoplasia

Three hundred and seven unselected patients were examined by double contrast barium enemas. Twenty-four patients (7.8%) had carcinomas; 11 patients (3.6%) had polyps; six patients (2%) had possible polyps, not confirmed by colonoscopy; and in four patients (1.3%) the radiological findings were misleading or wrong. No carcinoma was missed by barium enema X-ray examination, to be diagnosed by other means. Two patients had radiological lesions, not demonstrable endoscopically, but confirmed surgically. Extensive follow-up of 286 patients (93.2%) revealed only one subsequent case of carcinoma. The shortcomings of colonoscopy are briefly discussed. It is recommended that barium enema examination precede colonoscopy in the investigation of suspected large bowel neoplasia, and that both be used alternately to screen high-risk patients.