Comparative Analysis of Barium Enema and Computed Tomography Colonography

Abstract

Background: Large bowel lesions present a diagnostic challenge, with both benign polyps and colorectal cancer requiring accurate identification for effective treatment. Traditional diagnostic methods, notably barium enema (BE), have been hampered by limitations in sensitivity and patient comfort. This necessitates a critical evaluation of more advanced methods, such as computed tomography colonography (CTC), to improve diagnostic outcomes. Objective: This review narrative aimed to (i) conduct a thorough comparative analysis of BE and CTC, specifically concentrating on their diagnostic efficacy, patient experiences, and versatility in diverse clinical settings and (ii) provide clinicians with in-depth insights and actionable recommendations, aimed at enhancing the strategies for imaging and diagnosing large bowel lesions, as well as aiding in the effective setup and planning of diagnostic services. Methods: We conducted an exhaustive literature review across multiple databases including PubMed, MEDLINE, EMBASE, and the Cochrane Library. The selection criteria focused on studies that directly compared BE and CTC. We examined aspects such as diagnostic accuracy, patient experiences during the procedures, and their economic impact on healthcare systems. Results: The findings indicate a marked superiority of CTC over BE in terms of diagnostic sensitivity and specificity, particularly in polyp detection. CTC is shown to be more patient-centric, offering enhanced comfort and suitability, especially for vulnerable groups like the elderly and patients with conditions like renal insufficiency. Furthermore, the integration of CTC with ongoing technological advancements and adherence to contemporary clinical guidelines highlights its pivotal role in current preventive healthcare strategies. The application of CTC presents substantial benefits for long-term patient safety and demonstrates cost-effectiveness, making it a preferential choice for adoption in the radiology departments of new healthcare institutions. Conclusion: CTC stands out as a superior diagnostic tool for large bowel lesions, surpassing BE in effectiveness, patient comfort, and economic viability. It is in harmony with modern healthcare practices and is particularly advantageous in settings with ample resources. This review strongly supports a shift towards CTC in clinical settings, to enhance the quality of patient care and outcomes in the detection and management of colorectal lesions.