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Related Experiment Videos

Colonoscopy evaluations: justification by cost?

D K Rex, D Mark, B Clarke

    The American Journal of Gastroenterology
    |March 1, 1996
    PubMed
    Summary
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    For symptomatic patients without bleeding, initial colonoscopy is more effective and cost-effective for detecting adenomas than flexible sigmoidoscopy with barium enema. This approach also reduces the need for follow-up procedures.

    Area of Science:

    • Gastroenterology
    • Diagnostic Imaging
    • Health Economics

    Background:

    • Evaluating symptomatic patients without bleeding for colonic conditions involves debated imaging strategies.
    • The efficacy and cost-effectiveness of colonoscopy versus flexible sigmoidoscopy and air contrast barium enema remain key concerns.

    Purpose of the Study:

    • To compare the prevalence of neoplasm and the effectiveness of initial diagnostic strategies.
    • To evaluate the cost-effectiveness of colonoscopy versus flexible sigmoidoscopy plus air contrast barium enema in patients without bleeding.

    Main Methods:

    • A randomized controlled trial involving 149 patients over 40 with symptoms suggestive of colonic disease but no bleeding.
    • Patients were randomized to undergo either initial colonoscopy or flexible sigmoidoscopy plus air contrast barium enema.

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  • Cost analyses were performed using sensitivity analysis.

    • Main Results:

    • Initial colonoscopy detected more adenomas (23/75) compared to flexible sigmoidoscopy plus barium enema (13/74), approaching statistical significance.
    • Flexible sigmoidoscopy plus air contrast barium enema identified more cases of diverticulosis (46/74) than initial colonoscopy (31/75).
    • Eighteen patients (24%) initially receiving flexible sigmoidoscopy plus barium enema required subsequent colonoscopy, versus only five patients (6%) who underwent initial colonoscopy.

    Conclusions:

    • Initial colonoscopy is more effective in detecting adenomas and reduces the need for subsequent procedures compared to flexible sigmoidoscopy plus barium enema.
    • Sensitivity analysis suggests initial colonoscopy is more cost-effective for adenoma detection in most US regions.
    • The prevalence of cancer in this study cohort was low (1/149).