Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps ≥ 6 mm in the era of CT colonography

OBJECTIVE. The purpose of our study was to perform a meta-analysis comparing the performance of double-contrast barium enema (DCBE) with CT colonography (CTC) for the detection of colorectal polyps ≥ 6 mm using endoscopy as the gold standard. MATERIALS AND METHODS. Prospective DCBE and CTC studies were identified. Percentages of polyps and of patients with polyps ≥ 10 mm and 6-9 mm were abstracted. The performance of DCBE versus CTC was determined by separately evaluating each technique's performance versus that of endoscopy, and contrasting the techniques. The I-squared statistic and Fisher's exact test were used for heterogeneity, the Cochran-Mantel-Haenszel and the Kruskal-Wallis tests for correlation, and the A₂ test for comparing pooled weighted estimates of performance. RESULTS. Eleven studies of DCBE (5,995 patients, 1,548 polyps) and 30 studies of CTC (6,573 patients, 2,348 polyps) fulfilled inclusion criteria. For polyps ≥ 10 mm, a 0.121-perpatient sensitivity difference favored CTC (p < 0.0001; DCBE, 0.702 [95% CI, 0.687-0.715]; CTC, 0.823 [0.809-0.836]). For polyps ≥ 10 mm, a 0.031-per-polyp sensitivity difference favored CTC (p < 0.0001; DCBE, 0.715 [0.703-0.726]; CTC, 0.746 [0.735-0.757]). For polyps ≥ 10 mm, a specificity difference of 0.104 favored CTC (p = 0.001; DCBE, 0.850 [0.847-0.855]; CTC, 0.954 [0.952-0.955]). DCBE was also significantly less sensitive for 6- to 9-mm polyps (p < 0.001). CONCLUSION. DCBE has statistically lower sensitivity and specificity than CTC for detecting colorectal polyps ≥ 6 mm.