BOSTON, MASSACHUSETTS. Barium enemas have been used for many years in the detection of polyps, cancers, and lesions of the colon. In the 1970s with the development of fiberoptics colonoscopy came into being and by now has become the "gold standard" of colon examination. Dr. Robert Fletcher, MD of the Harvard Medical School now questions whether barium enemas should be used at all. He points to a recent study which concluded that the results of radiologic examination employing barium enemas are quite inaccurate when compared to the results of colonoscopy. The study involved 580 patients who were at increased risk for polyps. All patients underwent both colonoscopy and double-contrast barium enemas and the results were compared. Barium enema examinations found only about one third of the adenomas found upon colonoscopic examination and in 18 per cent of the examinations the barium enema procedure predicted a polyp which could not be confirmed in a second colonoscopy examination. The barium enema technique was particularly inaccurate in detecting small polyps (0.5 cm or smaller); it identified only 21 per cent of the number of polyps found by colonoscopy. Dr. Fletcher concludes that barium enema should only be used when colonoscopy is not available or is contraindicated.
Fletcher, Robert H. The end of barium enemas? New England Journal of Medicine, Vol. 342, June 15, 2000, pp. 1823-24 (editorial)