Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination

Abstract.Background: There is controversy regarding the most appropriate investigation for suspected colorectal carcinoma. We offered these patients same-day flexible sigmoidoscopy (FS) and double-contrast barium enema (DCBE).Methods: We reviewed the results of 117 consecutive adult patients. All patients underwent FS followed by DCBE on the same day. The radiographs were reviewed by two of the authors who were blinded to the clinical information, flexible sigmoidoscopy reports, and the original DCBE report.Results: One hundred seventeen patients made up the study population. Thirty-four of the 117 patients had polyps and/or carcinoma. Three malignant tumours were detected by DCBE; one of these was also seen on FS, and the other two cancers were out of FS range. Fifty-three polyps were found by FS; nine were removed by biopsy prior to the enema examination. Of the 44 remaining polyps, DCBE failed to detect 87% of the 0–9-mm group and 67% of the >9-mm group. Ten polyps were seen only on DCBE; seven of these 10 were beyond the range of the sigmoidoscope, and the three remaining polyps were less than 5 mm.Conclusion: DCBE is insensitive in the detection of rectosigmoid polyps. FS should continue to be used as a complementary examination to DCBE in the investigation of suspected colorectal carcinoma.