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A comparative study of double contrast barium enema and colonoscopy for evaluation of rectal bleeding in children
V Aggarwal1, S K Mittal, N Kumar
1Department of Pediatrics and Radiodiagnosis, Mulana Azad Medical College & Lok Nayak Jai Prakash Narain Hospital, New Delhi.
Insights
Double contrast barium enema (DCBE) and colonoscopy show comparable diagnostic accuracy for pediatric rectal bleeding. Both methods are valuable and complementary for evaluating children with this condition.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Endoscopy
Background:
- Rectal bleeding is a common concern in children.
- Limited comparative studies exist for diagnostic efficacy in pediatric patients.
- Evaluating rectal bleeding in children requires accurate diagnostic tools.
Purpose of the Study:
- To compare the diagnostic accuracy of double contrast barium enema (DCBE) and colonoscopy in children with overt rectal bleeding.
- To assess the sensitivity and specificity of both DCBE and colonoscopy.
- To determine the utility of these methods in identifying colonic lesions.
Main Methods:
- A prospective study involving 44 children with rectal bleeding.
- Independent performance of flexible colonoscopy and DCBE.
- Diagnosis established using a gold standard based on all investigations.
- Statistical analysis of sensitivity, specificity, and diagnostic yield for different lesion types.
Main Results:
- Colonoscopy sensitivity was 74.35% and specificity 100%.
- DCBE sensitivity was 66.66% and specificity 100%.
- DCBE showed higher yield for polypoidal lesions (86.20% vs. 72.41%), while colonoscopy was better for colitis (76.92% vs. 53.84%).
- Differences were not statistically significant; no major complications were reported.
Conclusions:
- Both DCBE and colonoscopy are effective in diagnosing rectal bleeding in children.
- The study highlights the complementary roles of DCBE and colonoscopy.
- These imaging modalities are valuable for pediatric rectal bleeding evaluation.
Abstract:
In pediatric age group, rectal bleeding is both common and distressing. Unlike in adults, very few studies comparing diagnostic efficacy of double contrast barium enema (DCBE) and Colonoscopy are available in children. A prospective study was performed to compare the diagnostic accuracy of high quality DCBE against colonoscopy in children with overt rectal bleeding. Fourty four children underwent flexible colonoscopy and DCBE independently. The final diagnosis was made after considering all investigations. Against this gold standard, the sensitivity and specificity of DCBE were 66.66% and 100% while that of colonoscopy 74.35% and 100% respectively. When assessing polypoidal lesions of colon, diagnostic yield of enema study was 86.20% as compared to 72.41% with colonoscopy. In colitis cases, the similar figures for enema and endoscopy were 53.84% and 76.92% respectively. The observed differences were statistically insignificant. No significant preparation, premedication or procedure related complications were encountered. The study thus highlights the utility and complementary role of DCBE and colonoscopy for evaluation of children with rectal bleeding.