Colorectal cancer double-contrast barium enema

CTC in symptomatic patients is to be considered when colonoscopy can not be completed or carried out this may occur due to mechanical hindrance such as pelvic adhesions, in cases of high risk of perforation as in complicated diverticular disease, when there is an obstruction due to cancer or extracolonic diseases, when the cecum cannot be reached in extreme dolicocolon conditions, or in patients with poor tolerance to colonoscopy in whom heavy sedation may be dangerous (elderly patients or patients with severe co-morbidity). Such indications are similar to those of double contrast barium enema (DCBE) however, CTC has been shown to be both more accurate and better tolerated than DCBE, and should be used preferentially whenever available (Rocket et al. 2005 Taylor et al. 2005 Taylor et al. 2006). Furthermore, in cases of obstructing colonic cancer, CTC is a valuable tool, as it can be conveniently performed at the time of a contrast-enhanced abdominal CT scan for staging purposes to detect synchronous colorectal carcinomas, metas-... 

Double contrast barium enema remains in the algorithm for work-up of colorectal cancer in evaluation of the proximal bowel in cases of an obstructing mass. This examination is not preferred, as the proximal colon often does not drain all of the barium by the time of surgery. Patients are also at increased risk for post-operative morbidity if a reactive peritonitis develops secondary to barium contamination intr a- operatively. 

Gluecker T, Johnson D, Harmsen W et al. (2003) Colorectal cancer screening with CT colonography, colonoscopy, and double contrast barium enema examination prospective assessment of patient perceptions and preferences. Radiology 227 378-384... 

Yet, there is low public acceptability of screening for colorectal cancer by colonoscopy, and a higher rate of patient compliance can be expected with CT colonoscopy (Gluecker et aL 2003), although the patient must undergo a colonic preparation, as with double-contrast barium enema or colonoscopy. Besides, if polyps or tumors are diagnosed by CT, conventional colonoscopy is required to verify the diagnosis, to obtain a biopsy sample, and to remove them. 

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