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

Background & Aims: The relative sensitivities of barium enema and colonoscopy for colorectal cancer are still debated. The aim of this study was to determine the relative sensitivity of barium enema and colonoscopy in general clinical practice. Methods: Medical records of 2193 consecutive colorectal cancer cases identified in 20 central Indiana hospitals were reviewed. All procedures performed within 3 years of the diagnosis were identified. Results: The sensitivity of colonoscopy for colorectal cancer (95%) was greater than that for barium enema (82.9%), with an odds ratio of 3.93 for a missed cancer by barium enema compared with colonoscopy. The sensitivity of double-contrast barium enema (85.2%) was not different from that of single-contrast (81.8%). Barium enema performed no better in the right than the left colon. Cancers detected by colonoscopy were more likely to be Dukes' class A (24.9%) than cancers detected by barium enema (9.8%). Colonoscopy performed by gastroenterologists was more sensitive (97.3%) for cancer than colonoscopy by non-gastroenterologists (87%), with an odds ratio of 5.36 for a missed cancer by a non-gastroenterologist compared with a gastroenterologist. Conclusions: Hospital quality assurance committees and/or third-party payers should review the sensitivity of barium enema and colonoscopy by practitioners in their institutions. Corrective measures are recommended when sensitivity deviates significantly below the standard set by gastroenterologists performing colonoscopy in this study.