Barium enema or colonoscopy for the investigation of iron deficiency anaemia?

Objective: To determine whether double contrast barium enema is adequate fo r excluding carcinoma of the colon in patients with iron deficiency anaemia . Design: Prospective audit. Subjects: One hundred and twenty-three patients with iron deficiency anaemi a. Intervention: All patients had upper intestinal (CI) endoscopy, duodenal bi opsy and double contrast barium enema. Malignant disease and other CI patho logy were treated. Patients with recurrent or persistent anaemia at follow- up were colonoscoped. Outcome measure: Colon cancer missed on barium enema examination but detect ed on colonoscopic examination. Results: An identified GI lesion contributing to their anaemia and 11 colon cancers were found in 71% of patients, all identified on barium enema. Two pre-cancerous conditions were missed on barium enema examination. Only 45% colonoscopies inspected the caecum. Conclusion: Double contrast barium enema with sigmoidoscopy is probably suf ficient for excluding carcinoma of the colon in iron deficiency anaemia.