Flexible Sigmoidoscopy and Double Contrast Barium Enema in Patients with Large Bowel Symptoms – Diagnostic Yield

Introduction: Flexible sigmoidoscopy (FS) combined with double contrast barium enema (DCBE) provides pancolonic imaging in patients with large bowel symptoms. The aim of this study was to assess the diagnostic yield of colorectal pathology in patients undergoing both FS and DCBE.

Methods: FS referrals were obtained from June 2000 to September 2002. Charts were reviewed.

Results: 165 patients (93 females [56%]; median age 61 years; range 44–86) were referred for FS±DCBE. Predominant large bowel symptoms were rectal bleeding, altered bowel habit or rectal bleeding with altered bowel habit combined. In rectal bleeding group (median age 60 years; range 47–86) 46 (85%) patients had both FS and DCBE. Findings correlated in 30 (65%) patients. In the altered bowel habit group (median age 63 years; range 47–85), 54 (93%) patients had both FS and DCBE. Findings correlated in 39 (72%) patients and differed in 15 (28%). In the combined symptom group (median age 58 years; range 44–78) 31 (81%) patients underwent both FS and DCBE. Findings correlated in 25 (81%), and differed in 6 (19%). Most frequent reasons investigation non-correlation were DD picked up on DCBE and not FS, or colitis and polyps picked up on FS and not on DCBE.

Conclusions: FS and DCBE findings correlated in the majority of cases. However, these data suggest that diagnostic yield in patients undergoing FS, particularly for left sided colonic symptoms, is increased little by DCBE.