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PubMedDate not supplied

Clinicopathologic significance of immunohistochemical fecal occult blood test in subjects receiving bidirectional endoscopy.

BACKGROUND/AIMS: Fecal occult blood test has been utilized to screen for lower gastrointestinal pathologies, such as colorectal cancer and polyps that bleed. Recent studies have revealed a relatively high frequency of upper gastrointestinal abnormalities in subjects with positive fecal occult blood by guaiac-based method. Although immunohistochemical tests of fecal occult blood were assumed to have greater diagnostic validity, the distribution of gastrointestinal pathology using such examinations is not well established. This study aims to investigate the efficacy of immunohistochemical analysis of fecal occult blood in detecting upper and lower gastrointestinal lesions in asymptomatic individuals. METHODOLOGY: Subjects who underwent regular health checkups were enrolled if they received both esophagogastroscopic and colonoscopic examinations. Each subject was tested by an immunohistochemical fecal occult blood test. The fecal occult blood results were evaluated and correlated with lesions identified in endoscopic examinations. RESULTS: In total 655 males and 722 females with age 46.2 +/- 12.1 years were enrolled, 287 cases (20.7%) had polypoid lesions of colon, including 6 colon cancers, 37 with polyps > or = 1 cm, 104 with polyp 5-9 mm, and 140 with polyp < 5 mm. FOB was positive in 31 cases, of which 15 (15/31, 48.4%) were polypoid lesions of colon, 1 was colonic ulcer, 9 (29.0%) were active gastroduodenal ulcers but 6 (19.4%) had no significant lesions. The positive and negative predictive value for colon polyps was 48.4% and 80%, respectively. The sensitivity was 50% (3/6) for colon cancer and varied among polyps with different sizes: 16.2% (6/37) for polyps > or = 1 cm; 5.8% (6/104) for polyps 5-9 mm and 0% (0/140) for polyps < 5 mm. CONCLUSIONS: A substantial portion of subjects (29%) with positive fecal occult blood reaction of immunohistochemical analysis but negative colonoscopy still needs esophagogastroscopic examination to disclose upper gastrointestinal lesions. Immunohistochemical determination of fecal occult blood remains imperfect for polypoid lesions of colon in view of its sensitivity and specificity.

Colonic Neoplasms↗
PubMed2000

Colorectal cancer in iron deficiency anemia with a positive result on immunochemical fecal occult blood.

We examined the relationships between iron deficiency anemia, immunochemical fecal occult blood test results, and colorectal cancer. Samples were collected from 17,664 asymptomatic individuals for an immunochemical occult blood test, and colonoscopy was carried out during medical check-up. The positivity rate on the occult blood test and detection rate for colorectal cancer were compared in those with and those without iron deficiency anemia. In addition, the detection rate for colorectal cancer was determined in four groups stratified by occult blood test results and the presence of iron deficiency anemia. The occult blood test was positive in 18.4% of those with and in 3.8% of those without iron deficiency anemia (P < 0.001), and colorectal cancer was detected in 2.7% of those with and in 0.4% of those without iron deficiency anemia (P < 0.05). The highest rate of colorectal cancer was found in subjects with both iron deficiency anemia and positive occult blood test result. These findings indicate positive associations between iron deficiency anemia and immunochemical occult blood test results, and between iron deficiency anemia and colorectal cancer. Colonoscopy is thus necessary particularly in cases of positive immunochemical occult blood test result and iron deficiency anemia.

Adult↗
PubMed1984

Immunochemical detection of fecal occult blood.

An immunochemical test for fecal occult blood has been evaluated. It has been found to be specific for human hemoglobin and to be reproducible, accurate and four times more sensitive than chemical occult blood tests. Storage of prepared slides at -20 degrees C prevented reduction in sensitivity. To determine the effect of blood from the upper gastrointestinal tract, six volunteers ingested 100 ml of their own blood. Positive chemical, but no positive immunochemical tests were produced. In 20 healthy subjects, challenge with red meat and vegetables with high peroxidase content increased the positivity rate of chemical tests but had no effect on the positivity rate of the immunochemical test. The immunochemical method for fecal occult blood has advantages over chemical testing in that it is specific for human blood and for lower gut bleeding. Its increased sensitivity should result in a high detection rate of colorectal neoplastic lesions. However, this same increased sensitivity may also reduce its effectiveness in bowel cancer screening because of positive results in patients with trivial blood loss from non-neoplastic colonic sources.

Adult↗
PubMed2001

One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon.

BACKGROUND: Fecal occult-blood testing and sigmoidoscopy have been recommended for screening for colorectal cancer, but the sensitivity of such combined testing for detecting neoplasia is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence of neoplasia and the sensitivity of one-time screening with a fecal occult-blood test plus sigmoidoscopy. METHODS: Asymptomatic subjects (age range, 50 to 75 years) provided stool specimens on cards from three consecutive days for fecal occult-blood testing, which were rehydrated for interpretation. They then underwent colonoscopy. Sigmoidoscopy was defined in this study as examination of the rectum and sigmoid colon during colonoscopy, and sensitivity was estimated by determining how many patients with advanced neoplasia had an adenoma in the rectum or sigmoid colon. Advanced colonic neoplasia was defined as an adenoma 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. Classification of subjects according to the findings was based on the most advanced lesion. RESULTS: A total of 2885 subjects returned the three specimen cards for fecal occult-blood testing and underwent a complete colonoscopic examination. A total of 23.9 percent of subjects with advanced neoplasia had a positive test for fecal occult blood. As compared with subjects who had a negative test for fecal occult blood, the relative risk of advanced neoplasia in subjects who had a positive test was 3.47 (95 percent confidence interval, 2.76 to 4.35). Sigmoidoscopy identified 70.3 percent of all subjects with advanced neoplasia. Combined one-time screening with a fecal occult-blood test and sigmoidoscopy identified 75.8 percent of subjects with advanced neoplasia. CONCLUSIONS: One-time screening with both a fecal occult-blood test with rehydration and sigmoidoscopy fails to detect advanced colonic neoplasia in 24 percent of subjects with the condition.

Adenoma↗
PubMed1996

Diagnostic accuracy of immunochemical faecal occult blood test for gastric cancer.

OBJECTIVES: To investigate the accuracy of the immunochemical occult blood test in screening for gastric cancer and to evaluate whether or not the upper digestive tract should be examined when the occult blood test is positive but there is no abnormal sign in the colorectum. METHODS: In a case-control study an occult blood test was carried out on 150 subjects with gastric cancer, 150 subjects with colorectal cancer, and on 300 healthy subjects. Data were analysed from 44,996 persons attending a population screening programme who underwent both radiological gastric cancer screening (barium meal) and colorectal cancer examination by occult blood test. RESULTS: In the case-control study the occult blood test was positive in 27/150 (18%) subjects with gastric cancer, in 112/ 150 (75%) subjects with colorectal cancer, and in 24/300 (8%) healthy controls. In the population screening programme the occult blood test was positive in 4/50 (8%) persons with gastric cancer and 3232/ 44,950 (7%) persons without gastric cancer, indicating no difference between them. CONCLUSIONS: These data show that the immunochemical faecal occult blood test is worthless as a screening test for gastric cancer, and that examination of the upper digestive tract is unnecessary in cases where the faecal occult blood test is positive but there is no sign of colorectal disease.

Case-Control Studies↗
PubMed1991

Intussusception and the diagnostic value of testing stool for occult blood.

A retrospective review was performed to determine the diagnostic value of testing for occult blood in stool of children suspect for intussusception. Ninety-six children had barium enema studies for suspected intussusception. Of the 57 children who had barium enema confirmed intussusception, 29 did not have history or physical findings of gross blood per rectum. Stool was tested for occult blood in 16 of these 29 patients, and 12 (75%) were positive. In comparison, three (20%) of the children who did not have intussusception had stool positive for occult blood. Stool with occult blood was significantly associated with intussusception (P less than .002). The only other clinical factor significantly associated with intussusception was abdominal mass (P less than .02). Vomiting, episodic irritability, poor feeding, abdominal pain and lethargy were not significantly different in the two groups. In conclusion, the authors suggest stool testing for occult blood when evaluating children who present with nonspecific signs and symptoms supportive of intussusception.

Barium Sulfate↗
PubMed1993

Report of colon cancer detection in mass surveys using immunological occult blood test (Latex method).

Occult blood test for the screening of colon cancer has been made by immunological method using latex agglutination for 4 years since 1988. A total of 35,139 persons have received the screening test and out of 1886 persons, that is, 5.4% showed positive. Five hundred seventy of the positive result subjects (30.2%) underwent barium enema examination. Three hundred fifty nine subjects (62.8%) showed some abnormal findings. They underwent colonoscopic examination and 45 of them (7.9%) had colon cancer. Twenty six of these were of early stage type and 19 persons were of advanced stage.

Adenocarcinoma↗
PubMed1987

The pros and cons of fecal occult blood testing for colorectal neoplasms.

Testing feces for occult blood is widely recommended as a means of detecting subclinical colorectal tumors. Guaiac tests such as Hemoccult are the most widely used, but chemical sensitivity is relatively low and the tests are affected by dietary peroxidases, the state of fecal hydration, and certain drugs. The newly devised HemoQuant and immunologic techniques appear more sensitive and specific, but they require further evaluation before widespread clinical usage can be recommended. Occult blood screening has both merits and weaknesses. Testing does uncover subclinical colorectal cancer, often at a relatively early stage, but whether this actually improves the prognosis remains to be proven. Benign neoplastic polyps are also detected, although it is debatable whether this is a valid rationale for screening. Test sensitivity for malignancy varies from good to moderate, but is poor for benign polyps. Specificity is usually around 97%-98%, yet the predictive value of a positive test for cancer is only about 10%; hence most test-positive individuals are needlessly subjected to invasive colonic investigations. Reported figures on public compliance with occult blood testing vary widely from excellent to poor. Published costs of screening are usually quite low, but these overlook important indirect and hidden expenses and are therefore misleading. On balance, the problems of occult blood testing currently appear to outweight the merits. This could change, however, with the newer testing techniques and with awaited mortality data from controlled clinical trials now underway.

Colonic Neoplasms↗
PubMed1997

Screening for colorectal cancer with the fecal occult blood test: a background paper. American College of Physicians.

PURPOSE: Screening for colorectal cancer with fecal occult blood tests or sigmoidoscopy can reduce mortality rates. If occult blood testing is done, clinicians must decide how to interpret the results and plan further management. If the results are positive, a decision must be made about evaluating the colon. This report provides information that can be used to perform fecal occult blood tests, interpret the results of those tests, and plan patient management. DATA SOURCES: The MEDLINE database was searched for data relevant to optimizing the technique of fecal occult blood testing. Studies were also identified from the bibliographies of published articles about test performance and the interpretation of test results, particularly sensitivity, specificity, and the probability of colorectal cancer after a positive test result. STUDY SELECTION AND DATA EXTRACTION: Studies were selected and data were extracted on the basis of the authors' combined judgment. DATA SYNTHESIS: When used for screening, fecal occult blood tests have positive results about 1% to 16% of the time, depending on such factors as the age of the person being tested, whether the sample is rehydrated, and whether the test is used for initial screening or for rescreening. When the colons of persons who have positive test results are evaluated, the rate of finding any colorectal cancer is about 2% to 17% and the rate for early colorectal cancer (Dukes stage A or B) is about 2% to 14%. CONCLUSIONS: These results suggest that, in general, persons who have positive results on a fecal occult blood test should have a full colonic examination. More research is needed to understand and improve the sensitivity and specificity of the fecal occult blood test.

Colorectal Neoplasms↗
PubMed2001

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma.

BACKGROUND AND AIMS: Testing for faecal occult blood has become an accepted technique of non-invasive screening for colorectal neoplasia but lack of sensitivity remains a problem. The aim of this study was to compare the sensitivity and specificity of faecal calprotectin and faecal occult blood in patients with colorectal cancer and colonic polyps. METHODS: Faecal calprotectin and occult blood were assessed in 62 patients with colorectal carcinoma and 233 patients referred for colonoscopy. The range of normality for faecal calprotectin (0.5-10.5 mg/l) was determined from 96 healthy subjects. RESULTS: Median faecal calprotectin concentration in the 62 patients with colorectal carcinoma (101 mg/l, 95% confidence interval (CI) 57-133) differed significantly from normal (2.3 mg/l, 95% CI 1.6-5.0) with 90% of patients having elevated levels (normal <10 mg/l) whereas only 36/62 (58%) had positive faecal occult bloods. There was no significant difference in faecal calprotectin levels when considering location or Dukes' staging of tumour. Percentage positivity of faecal occult bloods was significantly higher for Dukes' stage C and D cancers compared with Dukes' A and B. In the colonoscopy group, 29 patients with adenomatous polyps were detected in whom the median faecal calprotectin was 12 mg/l (95% CI 2.9-32). Sensitivity for detection of adenomatous polyps was 55% using the calprotectin method and 10% using faecal occult blood testing. The overall sensitivity and specificity of calprotectin for colorectal cancer and adenomatous polyps as a combined group was 79% and 72%, respectively, compared with a sensitivity and specificity of faecal occult blood of 43% and 92%. CONCLUSIONS: Faecal calprotectin is a simple and sensitive non-invasive marker of colorectal cancer and adenomatous polyps. It is more sensitive than faecal occult blood tests for detection of colorectal neoplasia at the cost of a somewhat lower specificity.

Adenoma↗
PubMed2003

A critical analysis of the routine testing of newborn stools for occult blood and reducing substances.

Stool tests for occult blood or reducing substances were introduced in the neonatal intensive care unit (NICU) as potential aids in the early recognition of necrotizing enterocolitis (NEC) in high-risk neonates, and have been recommended by some as routine nursing procedures. Neither the performance characteristics of these tests with respect to NEC, nor their indirect impact, were evaluated formally before widespread adoption into clinical care. The published evidence suggests that these tests are not useful as diagnostic or screening tools. There is no evidence that routine stool screening for occult blood or reducing substances predicts NEC or decreases the rate or severity of this disease. The direct costs of the tests are significant. A greater concern is their potential unintended consequences, which include the cost of secondary tests, restricted nutritional intake, and the accumulation of distracting, useless data. The logistics of maintaining quality control, the demands on nursing time, and the cost of testing are increasingly important considerations. This installment of Focus on the Physical diverges from a step-by-step systematic physical assessment by addressing the utility of testing neonatal stools for occult blood and reducing substances as aids in the early diagnosis or prevention of NEC. Using the information from these tests requires a framework for understanding their rationale, the test performance characteristics in the NICU setting, and the potential benefits, costs, and risks of their routine use.

Enteral Nutrition↗
PubMed1994

Effect of Storage Time and Temperature on Fecal Leukocytes and Occult Blood in the Evaluation of Travelers' Diarrhea.

Both the presence of fecal leukocytes and occult blood in stool specimens of travelers with diarrhea have been used as indicators of colonic inflammation due to bacterial infection. This study was conducted to determine if storage temperature of stool specimens can affect the detection of leukocytes and occult blood. Sixteen specimens positive for occult blood and 23 specimens positive for leukocytes were divided into two aliquots. Each aliquot was held at 4 degreesC or 25 degreesC and reexamined daily for fecal leukocytes or occult blood. Four percent of the positive leukocytes specimens and 56% of the occult blood positive specimens were still positive on the fifth day when they were held at 4 degreesC. When the samples were held at 25 degreesC, leukocytes could not be detected after 3 days, but 19% were positive for occult blood on the fifth day. The results indicate that storage temperature of stool specimens was associated with a difference in detection rate.

Journal Article↗
PubMed2006

Comparative evaluation of a new bedside faecal occult blood test in a prospective multicentre study.

BACKGROUND: Faecal occult blood testing is an established method of colorectal neoplasia screening. Guaiac-based tests are limited by poor patient compliance, low sensitivity, specificity and positive predictive value. Newer immunochemical-based tests, accurate but tedious, require a well-established laboratory set up. There is need for simpler immunochemical tests that can be performed at the out-patient clinic. AIM: To compare the performance characteristics of a new bedside immunological test strip device with a sensitive Guaiac-based and established immunochemical test for detection of faecal occult blood in patients undergoing colonoscopy. METHODS: A total of 389 consecutive patients from four centres who were referred for colonoscopy also provided the stool samples for detection of occult blood without dietary restrictions. Stool tests performed were (i) Guaiac-based, (ii) immunochemical enzyme-linked immunosorbent assay and (iii) bedside immunochemical strip test. RESULTS: At the optimal threshold level, the sensitivity and specificity of the beside immunochemical strip test for detection of significant colorectal neoplasia (adenomas >1.0 cm and carcinomas) were 60% and 95%, respectively. CONCLUSIONS: This bedside immunochemical strip test proved to be a simple, convenient, non-cumbersome and accurate tool with similar performance characteristics for detection of any bleeding lesion including colorectal neoplasia when compared with an established immunochemical faecal occult blood test.

Adolescent↗
PubMedDate not supplied

Association of diverticulosis coli and vascular ectasias and the results of fecal occult blood test.

BACKGROUND/AIMS: This study was conducted to clarify the diagnostic value of an immunochemical fecal occult blood test for diverticulosis coli and vascular ectasias of the colon, and to assess the association of these diseases to the results of fecal occult blood test. METHODOLOGY: An immunochemical fecal occult blood test over 2 consecutive days was carried out on 72 patients with diverticulosis coli, on 36 patients with vascular ectasias of the colon, on 36 patients with colon cancer, and on 144 healthy subjects. RESULTS: The test was positive in 13.8% patients with diverticulosis coli, in 11.1% patients with vascular ectasias, in 83.3% patients with colon cancer, and in 6.2% healthy subjects, respectively, showing a significant difference in the detection rate between colonic diverticulosis and colon cancer, between vascular ectasias and colon cancer (P < 0.001). However, there was no significant difference in the detection rate between diverticulosis coli and healthy subjects, and between vascular ectasias and healthy subjects. In addition, there was no significant association between the degrees of diverticulosis coli and vascular ectasias to the results of immunochemical fecal occult blood test. CONCLUSIONS: These findings indicate that the immunochemical fecal occult blood is unsuitable for the diagnosis of the patients with colonic diverticulosis and patients with vascular ectasias, and these disorders have little influence on the results of fecal occult blood test.

Colon↗
PubMed1996

Validity of immunological faecal occult blood screening for colorectal cancer: a follow up study.

OBJECTIVES: Immunological faecal occult blood testing has been recognised as a useful method for wide scale screening of colorectal cancer in Japan during the past few years. This study was carried out to evaluate the validity of an immunological faecal occult blood test for colorectal cancer screening. METHODS: A screening programme for colorectal cancer using an immunological faecal occult blood test was conducted on 3365 residents of regions within Nagano prefecture in 1991, and all the subjects were followed up for three years by verification from cancer registration. Based on the incidence of false negative cases among those who had been evaluated as normal by this screening, but were diagnosed as having colorectal cancer, the sensitivity and the specificity of this test were estimated. RESULTS: Four false negative cases were found during the subsequent three year follow up period after screening. Among these four cases, one case was within the first follow up year, one case within the second year, and two cases within the third year. Accordingly, the sensitivity of this test was calculated as 90.9% within one year, 83.3% within two years, and 71.4% within three years, while the specificity was found to be 95.6%, indicating a validity higher than that achieved by a chemical occult blood test. CONCLUSION: These findings suggest that the immunological faecal occult blood test has a high diagnostic accuracy and is a useful strategy for colorectal cancer screening.

Adult↗
PubMed1990

Is there a preference for different ways of performing faecal occult blood tests?

Low compliance with faecal occult blood screening reduces the power of clinical trials, potential benefit, and efficiency. It has been proposed that the faecal manipulation required to perform conventional guaiac based tests may be an important factor in low compliance. The aim of this study was to evaluate whether use of a new method (vehicle) of stool collection for the faecal occult blood guaiac test would be preferred to the established standard. A novel self-interpreted test, Early Detector (ED), requires the subject to apply a guaiac/peroxide spray to a stool sample collected simply by wiping the anus with a specimen pad. To determine whether this method would be preferred to the stool manipulation required by Haemoccult (HO) and to compare test validity, employees at a London company were invited to use both tests. Eight-hundred and fifty-seven subjects were shown both tests. Before use, 48% indicated a preference for the method of Early Detector; 24% chose Haemoccult (p less than 0.001), while 28% indicated no immediate preference. Seven-hundred and one performed both tests. After use, 74% preferred ED; 5% preferred HO (p less than 0.001); 21% had no preference (NP). The preference for the ED test method was consistent by sex categories, age groups and occupational class. Logistics, aesthetics, and immediacy of results were the main reasons indicated for choosing ED. Whether the preference for ED could result in higher compliance remains to be proven. Its high positivity (14%), however, would preclude its use as a sole test to determine the need for endoscopic and/or radiologic investigation in the screened patient.

Adult↗
PubMed2006

A quantitative immunochemical faecal occult blood test is more efficient for detecting significant colorectal neoplasia than a sensitive guaiac test.

BACKGROUND: The sensitive guaiac faecal occult blood test, Haemoccult SENSA (HOS; Beckman Coulter, Fullerton, CA, USA), is our standard screening test for significant colorectal neoplasia. We evaluated an automatically-developed, quantified human haemoglobin immunochemical faecal test, OC-MICRO (Eiken Chemical Co., Tokyo, Japan), to improve test specificity and so reduce the colonoscopy burden. AIM: To compare guaiac faecal occult blood test and immunochemical faecal test diagnostic efficacy and costs for identifying significant neoplasia. METHODS: Colonoscopies were performed on patients who prepared three daily guaiac faecal occult blood tests with or without immunochemical faecal tests. RESULTS: Total colonoscopy was performed on 151 subjects who prepared both guaiac and immunochemical faecal tests (group 1) and the positive predictive values (PPV) were also compared to those of 162 subjects undergoing colonoscopy for positive guaiac faecal occult blood tests (group 2). In group 1, comparative sensitivity, specificity, and PPVs for significant neoplasia with guaiac faecal occult blood test were 75%, 34%, and 12% (PPV, 18% for group 2) and with immunochemical faecal test were 75%, 94% and 60% (P < 0.01 for specificity). The number of colonoscopy examinations needed to detect a significant neoplasm because of positive faecal occult blood tests was six to eight with HOS and two with OC-MICRO at 21-31% the cost of evaluating a positive guaiac faecal occult blood test. CONCLUSION: An immunochemical faecal test maintains the high sensitivity of guaiac faecal occult blood test, but significantly reduces the colonoscopy burden and screening costs.

Aged↗
PubMedDate not supplied

Role of double-contrast barium enema in colorectal cancer screening based on fecal occult blood.

AIMS AND BACKGROUND: Screening for colorectal cancer by fecal occult-blood testing has been shown to be effective in reducing colorectal cancer mortality. Total colonoscopy is the test of choice for the assessment of fecal occult blood-positive subjects. Double-contrast barium enema is commonly employed to study the rest of the colon when colonoscopy is incomplete. The present study evaluated the contribution of double-contrast barium enema in detecting neoplastic lesions of the colon in fecal occult-blood-positive subjects with incomplete colonoscopy. METHODS: In the frame of a screening program for colorectal cancer in the Florence District, a new immunochemical fecal occult-blood test replaced the classic guaiac fecal occult-blood test in 1993. Subjects with a positive fecal occult-blood test were invited to undergo total colonoscopy. Incomplete colonoscopy prompted double-contrast barium enema. Type and rate of neoplastic lesions detected by endoscopy or double-contrast barium enema as single methods or combined were evaluated. RESULTS: A total of 38,829 subjects underwent fecal occult-blood testing in the period 1993-2000. Overall, 1,542 were positive. Assessment was refused by 235 subjects. Out of 1,307 subjects accepting assessment, total colonoscopy was attempted in 1,294: of these, it was not possible in 343 cases, and double-contrast barium enema was advised and performed in 261 subjects. Colorectal cancer was detected in 115 subjects, single or multiple adenomas in 323, hyperplastic polyps in 58, inflammatory, hamartomatous or not histologically confirmed polyps in 38, and other benign non-polypoid findings or no abnormality in 773. There were significant differences between the rates of detected colorectal cancers or adenomas of total and incomplete colonoscopy. There were also significant differences between incomplete colonoscopy and the combination of incomplete colonoscopy and double-contrast barium enema as regards rates of detected colorectal cancer, and between total colonoscopy and the combination of incomplete colonoscopy with double-contrast barium enema as regards rates of detected adenomas. Double-contrast barium enema associated to incomplete colonoscopy was responsible for an increase in detection rates of cancer or adenoma of 2.3/1000 or 3.8/1000, respectively. CONCLUSIONS: Double-contrast barium enema was useful in detecting colorectal cancer beyond the range reached by incomplete colonoscopy, whereas our data confirmed a lower sensitivity of double-contrast barium enema for polyps. The diagnostic contribution observed in the present survey confirms the opportunity of performing double-contrast barium enema as a routine adjunct to incomplete colonoscopy. Nevertheless, in order to maximize the detection rate of adenomas, the rate of total colonoscopy should be kept as high as possible.

Adenoma↗