Abstract
Background and Study Aims: In an ongoing screening study of 68 306 patients for early detection of colorectal
cancer, those with a positive Hemoccult II test (H2) were examined with a flexible
sigmoidoscope (60 cm) (FS) and double-contrast barium enema (DCE). The aim of this
study was to compare the results of FS and DCE examinations in the rectum and the
sigmoid colon, and to evaluate the benefit of DCEs.
Patients and Methods: 1831 FS and DCE examinations were performed on the basis of positive H2 tests (90 %
acceptance rate for positive Hemoccult tests). The radiologists were unaware of the
endoscopic findings. One hundred and thirty-five patients underwent total colonoscopy
due to abnormalities found on FS or DCE, or both. All patients were followed-up through
various Swedish cancer registers (range: 50-145 months).
Results: The sigmoidoscope was fully introduced in 71 % of cases, and the mean time for the
examination was 5 minutes. The combination of FS and DCE detected 235 adenomas of
1 cm and more, and 81 cancers which were in Dukes stages A (n = 29), B (n = 22), and
C (n = 23). Twenty-one cancers (26 %) and 24 adenomas (10 %) identified on DCE were
above the rectosigmoid area. The rate of overlooked adenomas (≥ 1.0 cm) and cancers
was 22 and five for FS in the rectosigmoid area, and 55 and 15, respectively, for
DCE. Adenomas found in the rectosigmoid area were only rarely associated with more
proximal adenomas of 1 cm and more (1 %).
Conclusions: This approach - screening by FS and DCE, and selective use of colonoscopy in case
of abnormalities - leads to the diagnosis of significant colonic tumors (larger adenomas
and cancers) in 17.7 % of cases; only two of eighty-three cancers (2.4 %) were overlooked
with this method.
