Durdey P, Weston P M, Williams N S
Lancet. 1987 Sep 5;2(8558):549-51. doi: 10.1016/s0140-6736(87)92931-x.
To determine whether double-contrast barium enema (DCBE) or fibreoptic examination should be the first-line investigation for colonic disease 76 consecutive patients presenting for the first time to the outpatient clinic with symptoms of colonic disease deemed to need a DCBE after negative rigid sigmoidoscopy were entered into a trial. All underwent flexible sigmoidoscopy, then DCBE, and finally colonoscopy. 66 patients completed the study. DCBE alone gave the final diagnosis in 42 (67%) and colonoscopy alone in 60 (91%) (p = 0.0004). A combination of flexible sigmoidoscopy and DCBE led to the diagnosis in 50 patients (76%). With DCBE alone 73% of polyps and 64% of patients with inflammatory bowel disease were missed. No complications arose from the investigations. 32 (48%) patients found DCBE distressing and 15 (23%) found colonoscopy uncomfortable (p = 0.004). Its high diagnostic accuracy and relative lack of discomfort for patients make colonoscopy the primary procedure for investigating patients with large bowel symptoms referred to the general surgeon.
为了确定双重对比钡剂灌肠（DCBE）或纤维光学检查是否应作为结肠疾病的一线检查方法，76例首次到门诊就诊且有结肠疾病症状、硬性乙状结肠镜检查阴性后被认为需要进行DCBE的患者进入了一项试验。所有患者均接受了柔性乙状结肠镜检查，然后是DCBE，最后是结肠镜检查。66例患者完成了研究。仅DCBE得出最终诊断的有42例（67%），仅结肠镜检查得出最终诊断的有60例（91%）（p = 0.0004）。柔性乙状结肠镜检查和DCBE相结合使50例患者（76%）得到诊断。仅使用DCBE时，73%的息肉和64%的炎症性肠病患者被漏诊。检查未出现并发症。32例（48%）患者觉得DCBE令人痛苦，15例（23%）患者觉得结肠镜检查不舒服（p = 0.004）。结肠镜检查对患者具有较高的诊断准确性且相对不那么不舒服，这使其成为普通外科医生对有大肠症状患者进行检查的主要方法。
