No prospective randomized trial of air contrast barium enema (ACBE) has been conducted in average-risk populations. ACBE has been shown to be at least 70% sensitive for identifying large polyps and cancer. Despite the absence of definitive, prospective data, the long history of clinical application of ACBE has earned this modality a place in the recommendations of authoritative groups (American Cancer Society, American Gastroenterology Association, American College of Gastroenterology, and others).
As an adjunct to the National Polyp Study (colonoscopy follow-up of patients after adenoma polypectomy), paired ACBE and colonoscopy was performed in nearly 600 subjects as follow-up after endoscopic polypectomy (Winawer et al, 2000). If colonoscopy is taken as a "gold standard," ACBE was 32% sensitive for the detection of polyps up to 5 mm, 53% sensitive for the detection of 6- to 10-mm polyps, and 48% sensitive for the detection of polyps larger than 10 mm. In fact, colonoscopy did miss a small number of adenomas. Overall, colonoscopy was considered superior. It should be emphasized that the population was by no means average risk. Although by definition all subjects were regarded as at high risk by virtue of their adenoma history, all had already undergone removal of these adenomas at least once, perhaps rendering these patients at low risk.
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