The value of colonoscopy and double-contrast barium-enema examinations in the evaluation of patients with subacute and chronic lower intestinal bleeding.

Abstract

A total of 136 consecutive patients with histories of guaiac positive stool examinations, bright red blood per rectum or hematochezia to determine the value of the double-contrast Ba enema (DC-BE) examination and colonoscopy/proctoscopy in estabishing bleeding sites. If examination findings were analyzed in conjunction with findings of visual examination of the anal area, the difference in the respective sensitivities of the 2 examinations was not statistically significant. If findings at the visual inspection were excluded, the DC-BE examination missed 45 of 155 proved bleeding sites (sensitivity, 71%) and 13 of 35 nonbleeding lesions (sensitivity for all lesions 70%), while colonoscopy missed 13 of 155 bleeding sites (sensitivity, 92%) and 7 of 35 nonbleeding lesions (sensitivity for all lesions, 90%). The sensitivity of both methods was similar if all rectal and anal lesions were excluded. Only 8 additional lesions (all polyps) were found in 78 patients who had bleeding internal and external hemorrhoids, anal fissures and anal tears and 7 of these were found in patients who were older than 50 yr of age. Colonoscopy apparently is superior to the DC-BE examination in the detection of bleeding sites, but similar in results to the DC-BE examination if lesions in the anal canal and rectum are excluded. The routine use of the DC-BE examination in patients with superficial lesions in the anal canal should be discouraged unless the patient has persistent bleeding or is 50 yr old or older.