Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice

Background & Aims: The relative sensitivities of barium To better understand the relative performance of coenema and colonoscopy for colorectal cancer are still lonoscopy and barium enema in clinical practice, we debated. The aim of this study was to determine the identified 2193 consecutive cases of colorectal cancer in relative sensitivity of barium enema and colonoscopy 20 different hospitals in central Indiana and determined in general clinical practice. Methods: Medical records the diagnostic procedures performed in these patients in of 2193 consecutive colorectal cancer cases identified the 3-year period preceding the diagnosis and whether in 20 central Indiana hospitals were reviewed. All pro- colonoscopy or barium enema had detected the cancer. cedures performed within 3 years of the diagnosis were To our knowledge, this is the first large study to deteridentified. Results: The sensitivity of colonoscopy for mine the relative sensitivity of colonoscopy and barium colorectal cancer (95%) was greater than that for barenema for detection of colorectal cancer in a broad range ium enema (82.9%), with an odds ratio of 3.93 for a missed cancer by barium enema compared with colon- of clinical practice environments and a geographic region. oscopy. The sensitivity of double-contrast barium enema (85.2%) was not different from that of single-con