Referrals for Double-Contrast Barium Examination: Factors Influencing the Probability of Finding Polyps or Cancer

Abstract

Predictors of the radiologic detection of colorectal polyps or cancer were studied in 1852 patients referred from primary health care for a double-contrast barium enema. Significant polyp predictors were age 40-79 years (odds ratio (OR), 2.4-5.0) and rectal bleeding (OR, 1.8). Previous colorectal neoplasm, familial history of cancer in general, and male sex were nearly significant predictors of polyps. Significant cancer predictors were age > or = 60 years (OR, 8.6-27.8), rectal bleeding (OR, 2.7), loss of weight (OR, 2.6), and male sex (OR, 2.2). Fatigue and abdominal pain were nearly significant negative predictors for cancer. No association was found between patient delay and the detection of polyps or cancer. Physician delay was significantly shorter in patients with cancer than in cancer-free patients. Age was the most important predictor for the detection of both polyps and cancer, more important than symptoms and history, including family history.

Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review

“…Forty papers provided information about the relationship between bleeding (of any type) and colorectal cancer [13-21,23-28,30,32,33,35,37,41,42,45-47,50,51,54-56,60-66,69,72,73], and 23 of these papers [13-17,20,21,23,24,26,28,30,33,41,42,46,47,54,56,61,63,72,73] also provided information about the relationship between bleeding and polyps.…”

Diagnostic utility of alarm features for colorectal cancer: systematic review and meta-analysis

“…Symptom data were collected using a questionnaire in seven studies,17 18 26 27 29 31 34 via clinical history in three studies,16 32 33 and the method of collection was unclear in the remaining studies. One study used barium enema alone as the lower GI investigation of choice,29 and no study used CT colography alone.…”

“…Symptom data were collected using a questionnaire in seven studies,17 18 26 27 29 31 34 via clinical history in three studies,16 32 33 and the method of collection was unclear in the remaining studies. One study used barium enema alone as the lower GI investigation of choice,29 and no study used CT colography alone. Several studies included patients who required endoscopic visualisation of abnormalities detected at barium enema, or who were asymptomatic but undergoing follow-up or surveillance for previous colorectal carcinoma, polyps or inflammatory bowel disease 16 27 28 31 33 35 36.…”

“…We identified five studies evaluating weight loss in 7418 patients,17 18 29 31 34 with a pooled prevalence of colorectal cancer of 6% (95% CI% 4% to 8%). Overall, the pooled prevalence of weight loss in the studies was 12% (95% CI% 6% to 20%).…”

“…The reasons for this are speculative, but may reflect a degree of selection bias. Eleven of the studies stated that recruitment had been prospective, nine that they had included consecutive patients, only one study specified that investigators were blinded to patient data,29 and in four studies clinical data were collected by the doctor performing the investigative procedure,27 31 – 33 though the latter would be expected to bias studies towards overestimating the accuracy of alarm features in diagnosing colorectal cancer.…”