The fluoroscopic barium enema in colonic polyp detection

The results of 1,500 barium enema studies done by vigorous manual palpation under fluoroscopy were reviewed to determine the adequacy of this technique in detecting polyps above the proctoscopic level. Of the 1,500 patients examined, 103 (7%) were diagnosed radiographically as having a total of 149 polyps. Polyps were found at proctoscopy in about 10% of the 1,500 patients. Colonoscopy or surgery was performed on 35 of the 103 patients. Of the 52 polyps discovered during these procedures, only three were missed at fluoroscopic barium enema study, a false-negative rate of 6%. Fourteen patients whose barium enemas initially were reported as negative for polyps or neoplasia had colonoscopy. Two of the 14 patients had positive findings, for a true-negative rate of 86%. If the detection rate of 7% found at barium enema, taking into account an overlap of 10%, is combined with the rate of 7.5% found at proctoscopy, a frequency of about 14% emerges in detecting polyps in the rectum and in the colon. Thus, the fluoroscopic barium enema when combined with proctoscopy is a sensitive method in the detection of colorectal polyps. In addition, it has the advantage of rapid execution and relatively low cost.