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It is surprising that NICE recommends barium enema as the preferred radiological method for diagnosing colorectal cancer in patients with significant co-morbidities.1
New data from Special Interest Group in Gastrointestinal and Abdominal Radiology (SIGGAR) 1 have shown CT colonography detects significantly more cancers than barium enema.2 Moreover, CT colonography is better tolerated than barium enema.3 In many hospitals barium enemas have been superseded by CT colonography and newly qualified radiologists are now more likely to have expertise in CT colonography than in performing and interpreting barium enemas.
Barium enema requires similar bowel preparation and levels of mobility as colonoscopy and arguably if a patient is fit for a barium enema they are also fit for a colonoscopy (especially as colonoscopy is now often performed without sedation). Furthermore, these guidelines give no advice regarding those patients who may not be able to tolerate full bowel preparation. For these patients minimal preparation CT with oral contrast (faecal tagging) is a suitable option and has a reported negative predictive value for colorectal cancer of more than 90%.4
1) Poston GJ, Tait D, O’Connell S, Bennet A, Berendse S. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ 2011;343:d6751.
2) Wylie PN, Burling D. CT colonography: what the gastroenterologist needs to know. Frontline Gastroenterol 2011;2:90-95.
3) Bosworth HB, Rockey DC, Paulson EK, et al. Prospective comparison of patient experience with colon imaging tests. Am J Med 2006;119:791–9.
4) Koo BC, Ng CS, U-King-Im J, Prevost AT, Freeman AH. Minimal preparation CT for the diagnosis of suspected colorectal cancer in the frail and elderly patient. Clin Radiol 2006;61: 127–139.
Re: Diagnosis and management of colorectal cancer: summary of NICE guidance
It is surprising that NICE recommends barium enema as the preferred radiological method for diagnosing colorectal cancer in patients with significant co-morbidities.1
New data from Special Interest Group in Gastrointestinal and Abdominal Radiology (SIGGAR) 1 have shown CT colonography detects significantly more cancers than barium enema.2 Moreover, CT colonography is better tolerated than barium enema.3 In many hospitals barium enemas have been superseded by CT colonography and newly qualified radiologists are now more likely to have expertise in CT colonography than in performing and interpreting barium enemas.
Barium enema requires similar bowel preparation and levels of mobility as colonoscopy and arguably if a patient is fit for a barium enema they are also fit for a colonoscopy (especially as colonoscopy is now often performed without sedation). Furthermore, these guidelines give no advice regarding those patients who may not be able to tolerate full bowel preparation. For these patients minimal preparation CT with oral contrast (faecal tagging) is a suitable option and has a reported negative predictive value for colorectal cancer of more than 90%.4
1) Poston GJ, Tait D, O’Connell S, Bennet A, Berendse S. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ 2011;343:d6751.
2) Wylie PN, Burling D. CT colonography: what the gastroenterologist needs to know. Frontline Gastroenterol 2011;2:90-95.
3) Bosworth HB, Rockey DC, Paulson EK, et al. Prospective comparison of patient experience with colon imaging tests. Am J Med 2006;119:791–9.
4) Koo BC, Ng CS, U-King-Im J, Prevost AT, Freeman AH. Minimal preparation CT for the diagnosis of suspected colorectal cancer in the frail and elderly patient. Clin Radiol 2006;61: 127–139.
Competing interests: No competing interests