Barium enema and endoscopy for the detection of colorectal neoplasia: Sensitivity, specificity, complications and its determinants

AIM: To analyse sensitivity, specificity and complication rate of endoscopy , and barium enema for the detection of colorectal neoplasia. MATERIALS AND METHODS: A MEDLINE search was performed (1980-2000) directed at the endoscopic and radiologic literature on barium enema. Articles were selected based on the type of study, availability of sensitivity and specif icity values in sizeable patient groups, and reports on complications. Sixt y articles were included in the analysis. RESULTS: Endoscopy proved to have superior sensitivity for polyps in patien ts at high-risk for colorectal neoplasia. The role of endoscopy and radiolo gy in average-risk screening populations is not known. Sensitivity and spec ificity rates ranged widely, probably due to bias. For the detection of sma ll polyps endoscopy has superior performance, whereas sensitivity is simila r for endoscopy and barium enema for the detection of larger (>1 cm) polyps and tumours. Overall, endoscopy is associated with a higher complication r ate. CONCLUSION: Endoscopy is the preferred detection method in high-risk patien ts. The role of endoscopy and radiology in a screening setting requires eva luation. This review provides the test characteristics of endoscopy and rad iology which are relevant for a cost-effectiveness analysis. Double-contras t barium enema may play an important rob for screening purposes, owing to i ts good sensitivity for detecting larger (>1 cm) polyps and its lack of maj or complications, (C) 2001 The Royal College of Radiologists.