Barium enema or colonoscopy for the investigation of iron deficiency anaemia?

Objective: To determine whether double contrast barium enema is adequate for excluding carcinoma of the colon in patients with iron deficiency anaemia.

Design: Prospective audit.

Subjects: One hundred and twenty-three patients with iron deficiency anaemia.

Intervention: All patients had upper intestinal (GI) endoscopy, duodenal biopsy and double contrast barium enema. Malignant disease and other GI pathology were treated. Patients with recurrent or persistent anaemia at follow-up were colonoscoped.

Outcome Measure: Colon cancer missed on barium enema examination but detected on colonoscopic examination.

Results: An identified GI lesion contributing to their anaemia and 11 colon cancers were found in 71% of patients, all identified on barium enema. Two pre-cancerous conditions were missed on barium enema examination. Only 45% colonoscopies inspected the caecum.

Conclusion: Double contrast barium enema with sigmoidoscopy is probably sufficient for excluding carcinoma of the colon in iron deficiency anaemia.