Double Contrast Barium Enema

Double contrast barium enema (DCBE) may be offered as a screening method for CRC. There are no randomized trials evaluating the impact of DCBE on CRC incidence or mortality in average risk individuals.

DCBE  can detect large clinically relevant lesions, but it is less sensitive than colonoscopy.  FS is not recommended as an addition to DCBE in the setting of CRC screening, because the increase in detection rate is probably small and is felt to be offset by the cost and inconvenience of FS. (5)
If DCBE is used as the screening method of choice, it is recommended every five years.

Performing the Test
X-rays are taken after the patient is given an enema with barium and air is introduced in to the colon. The barium and air help to outline the colon and rectum, making abnormalities easier to detect.  The test, involving multiple xrays with different positioning, takes about half an hour.  DCBE requires bowel preparation similar to that for colonoscopy.

Risks of the Test

Perforation rates for DCBE are estimated to be about 1:25,000. (15) 

Interpreting the Test
DCBE is less sensitive than colonoscopy in detecting large polyps and cancers.  It does not allow for the removal of polyps or the biopsy of suspicious lesions, and it is more likely to identify artifacts, such as stool, as colonic lesions.  People with an abnormal DCBE require colonoscopic evaluation. If abnormalities are found, DCBE should be followed by colonoscopy.

 

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Module III - Table of Contents Page 6