Flexible fiberoptic sigmoidoscopy and double-contrast barium-enema examination in the identification of adenomas and carcinoma of the colon

Abstract

To assess the accuracy of the flexible fiberoptic sigmoidoscope, 227 consecutive patients (mean age 61.8 .+-. 13 yr) requiring investigation of colonic symptoms were evaluated using rigid and flexible sigmoidoscopy (PAF and KDV) and double-contrast Ba enema (SSA). Patients with equivocal findings or adenomatous polyps underwent colonoscopy (TWB). Thirty-four patients had carcinoma and 50 patients had 1 or more adenomatous polyps (> 5mm). The neoplastic yield from rigid sigmoidoscopy was 12%, flexible fiberoptic sigmoidoscopy 90%, and double-contrast Ba enema only 76%. Ba enema failed to identify 8 carcinomas and 13 adenomatous polyps; 7 of the 8 carcinomas were polypoid Dukes'' Stage A lesions, and associated diverticular disease was present in 62.5% of cases. Flexible fiberoptic sigmoidoscopy failed to identify 7 carcinomas and 1 adenomatous polyp. Five of the carcinomas were beyond range of the instrument; in 1 patient, a stricture was seen that was caused by the carcinoma; and in the 7th patient, the examination was terminated because of angulation spasm. Double-contrast Ba enema is inaccurate in detecting lesions in the sigmoid colon, with flexible sigmoidoscopy being superior.