Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding

Douglas K. Rex, Richard A. Weddle, Glen A. Lehman, David C. Pound, Katherine W. O'Connor, Robert H. Hawes, Robert S. Dittus, John C. Lappas, Lawrence Lumeng

Research output: Contribution to journalArticle

92 Scopus citations

Abstract

A randomized, controlled trial was performed to compare the diagnostic yields and cost-effectiveness of two strategies for the evaluation of nonemergent lower gastrointestinal bleeding. Three hundred eighty patients aged ≥40 yr were randomized to undergo initial flexible sigmoidoscopy plus air contrast barium enema or colonoscopy; 332 completed the initial studies. Initial colonoscopy detected more cases of polyps <9 mm in size, adenomas, and arteriovenous malformations but fewer cases of diverticulosis. No significant difference was found between strategies in the number of patients detected with cancers or polyps ≥9 mm in size. In both strategies, cancers were more common in subjects aged ≥55 yr (8% overall) than in those aged <55 yr (1%). Among patients aged <55 yr with suspected lower gastrointestinal bleeding, initial flexible sigmoidoscopy plus air contrast barium enema is a more cost-effective strategy for the detection of colonic neoplasms than initial colonoscopy. However, initial colonoscopy is more cost effective for those aged ≥55 yr.

Original languageEnglish (US)
Pages (from-to)855-861
Number of pages7
JournalGastroenterology
Volume98
Issue number4
DOIs
StatePublished - Apr 1990

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Rex, D. K., Weddle, R. A., Lehman, G. A., Pound, D. C., O'Connor, K. W., Hawes, R. H., Dittus, R. S., Lappas, J. C., & Lumeng, L. (1990). Flexible sigmoidoscopy plus air contrast barium enema versus colonoscopy for suspected lower gastrointestinal bleeding. Gastroenterology, 98(4), 855-861. https://doi.org/10.1016/0016-5085(90)90007-N