Colonic investigations in the elderly: colonoscopy or barium enema?

Colonoscopy (CS) is currently considered the best diagnostic procedure for colonic imaging. The objectives of this multicentric study were to assess whether CS or simple contrast barium enema (SCBE) has the best effectiveness and tolerance in the elderly (over 80 years old). Except in cases of emergency, 67 elderly patients from 3 centers were randomized among three diagnostic strategies: CS, SCBE or barium enema+rectosigmoidoscopy (BERS). CSs were generally carried out after polyethylene-glycol (PEG) cleansing, and barium enemas after enema cleansing. The diagnostic effectiveness of the three strategies was not significantly different: a colonic abnormality was found in CS, SCBE, BERS groups in 65, 56 and 71% of the cases, respectively. No other investigation was needed in 61 to 76% of cases, and, on the basis of the exploration, final therapy was modified in less than 22% of cases. Overall cleansing quality was significantly better with barium enema (84.1%) than with CS (57.0%; p < 0.05). This was explained by a poor tolerance to PEG intake, which led to 28.2% of adverse effects, compared with 7.1% after enema preparation (p < 0.05). This resulted in a significantly higher failure rate of complete colonic exploration with CS (48%) than with barium enema (9%; p < 0.001). In conclusion, the effectiveness of the three diagnostic strategies is similar in the elderly. However, due to a better acceptance of the enema preparation, and to a better success rate of complete exploration, SCBE should be preferred to investigate colonic symptoms when the above preparations are used.