Radiology, Vol 195, 777-784, Copyright © 1995 by Radiological Society of North America
Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?
S Karasick, SM Ehrlich, DC Levin, RJ Harford, EF Rosetti, JA Ricci, LM Beam and JV Gigliotti
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
PURPOSE: To assess replacement of barium enema examination with colonoscopy
in relation to age- and sex-related risk factors, place of service,
physician specialty, and cost. MATERIALS AND METHODS: Between 1985 and
1992, 894,777 insurance claims for barium enema examination and lower
gastrointestinal endoscopy were retrospectively examined. Changes in use
were investigated. Use of proctosigmoidoscopy and flexible sigmoidoscopy,
two office-based endoscopic procedures, was also examined. RESULTS: Use of
diagnostic colonoscopy increased from 191 to 406 services per 100,000
persons; colonoscopy with biopsy, from 77 to 183 services; and colonoscopy
with lesion removal, from 77 to 202 services. Barium enema examination use
declined from 929 to 511 services per 100,000 persons; diagnostic
proctosigmoidoscopy, from 854 to 193 services; and diagnostic flexible
sigmoidoscopy, from 656 to 620 services. Increases in use of colonoscopy in
patients aged younger than 40 years were greater than overall increases.
CONCLUSION: Colonoscopy has been replacing barium enema examination as the
initial colorectal examination since 1985. Increased use of colonoscopy in
patients with lower risk of neoplasia suggests that indications have become
overly broad.
