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The purpose of this study was to compare double-contrast barium examination (DCBE) and endoscopy in detection of small colonic polyps. In 57 patients DCBE revealed 106 polyps in the large intestine. On total colonoscopy, 62 polyps could be verified. The size of the polyps excised ranged from 2 to 15 mm. Compared with DCBE, colonoscopy verified 48 true positive, 44 false positive and 14 false negative polyps. In revealing a polyp less than 5 mm, DCBE had a sensitivity of 72%, whereas in detection of larger polyps the sensitivity was 81%. Histological verification was available in 52 of the 62 removed polyps. A tubular adenoma was found in 12 of the 29 diminutive polyps verified with histology. DCBE and colonoscopy could not differentiate between adenomas and hyperplastic polyps. Since a polyp less than 5 mm may represent an adenoma, a precancerous lesion, its removal is indicated during colonoscopy after DCBE has detected it.

All 1358 referrals for barium enemas at Bristol Royal Infirmary in 1981 were studied. The overall diagnostic yield for colonic or distal ileal pathology was 33% with 75 (5.5%) cancers detected. General practitioner requested enemas constituted 25.8% of the total undertaken and their diagnostic yield was equal to hospital outpatient requested enemas. Medical and surgical diagnostic yields were similar for both inpatient and outpatients though the indications varied. Women predominated by 3:2 in all age groups. In the under 40's the yield was low (19.8%) except for inflammatory bowel disease. When related to symptoms the lowest yield was obtained for the investigation of abdominal pain (25%), particularly in women, except in those admitted as inpatients. The clinicians were wrong in diagnosing abdominal or pelvic masses as being of colonic origin in over 50% of cases. It is suggested that yield could be improved by being more selective in patients under 40, more use being made of suitable faecal occult blood testing, and ultrasonic scanning of abdominal masses before barium enema.

Although most causes of chronic anorectal bleeding are diagnosed from clinical or sigmoidoscopic examination, there are a number of conditions not detectable from barium enema studies. Results of colonoscopy are compared to those for single- and double-contrast barium enema examinations, and recommendations are made for increasing diagnostic accuracy.

This study was undertaken to evaluate the radiological diagnosis of colorectal polypoid lesions between 0.6 cm and 3.0 cm in size. Lesions less than 0.6 cm were mostly benign or, on rare occasions, early carcinomas limited to the mucosa. Lesions more than 3.0 cm in size were mostly advanced carcinomas. Lesions were classified by modified Maruyama's classifications as follows, type "a" (lesion with long stalk), type "b" (lesion with short or sessile lesion), type "c" (plaque-like lesion), type "d" (lesion with central depression) and type "e" (the others). Type "a" lesions were either benign or early cancers but these could not be distinguished radiologically. Type "b" and "c" lesions more than 1.0 cm in size and with indentation of colonic wall, had a great probability of being early cancer. Type "d" lesions with a slight depression were either benign or early cancers but type "d" lesion with a moderate depression were all advanced cancers. Type "e" lesions were mostly villous tumors so that it was difficult to diagnose whether these were cancer or not.

Colonoscopically verified lesions (230 in 178 patients) were reviewed and compared to results of double-contrast barium enema studies performed by radiologists specifically interested in gastrointestinal disease. Eighteen carcinomas and 22 cases of colitis found endoscopically were accurately identified radiographically. In 140 patients with 190 polyps, 16 lesions were missed radiologically, a false-negative error for polyps of 8.4%. All undetected polyps were distal to the splenic flexure with the majority located in the sigmoid colon. Thus, the double-contrast barium enema study was quite effective in finding colon polyps, particularly proximal to the splenic flexure.

Rectal tumors are rare in childhood. The description of both hamartomatous inverted polyps of the rectum and polymalformative syndrome in the same adolescent, gives the opportunity to remind the manifestations of this unusual tumor and to bring an additional argument to the Schannon Allen's malformative theory.

Fifty-one colon neoplasms larger than 1 cm were diagnosed by double-contrast barium enema (DC), but were not confirmed by initial endoscopy. Seventeen lesions were shown to be radiographic false-positive diagnoses by careful review of the original radiographs (10 cases) or repeat DC (7 cases). The presence of a neoplasm was confirmed in 21 cases (41%) by repeat endoscopy or surgery (15 cases) or by repeat DC alone (6 cases). Seven (47%) of 15 resected lesions were malignant. The results emphasize the complementary nature of the DC and endoscopy in detection of colon neoplasms. When discrepancies between the radiographic and endoscopic diagnoses cannot be explained by careful review of the DC, repeat radiographic or endoscopic examination should be performed.

Knowledge of normal and pathological anatomy and the radiological picture of the ileocecal valve is very important to avoid false interpretation of polyp-like findings in the cecum. Radiologically, ileal prolapse can pose as a cecal polyp. The radiological diagnosis, large 'cecal polyp' was not confirmed intraoperatively in the case presented.

Various types of polypoid lesions are found in patients with ulcerative colitis and Crohn's disease. True adenomatous polyps are rare. In addition to the sessile or pedunculated "pseudopolyps" of inflammatory bowel disease, the lesions may also assume a filiform shape or reach a giant size. These polypoid lesions are inflammatory in nature and therefore have no malignant potential. Awareness of the benign nature of these lesions is important in the management of patients with inflammatory bowel disease. Unnecessary surgery may be prevented by endoscopic biopsy for confirmation of their inflammatory nature. Representative cases illustrate the ability of the double contrast technic to clearly depict these polypoid lesions.

With experience, air contrast examination of the esophagus, stomach, and duodenum can be performed routinely as quickly and easily as the standard UGI. The air contrast examination is superior for detection of small gastric polyps and the Japanese have found it superior for detection of early carcinoma. The postoperative stomach and the fundus and cardia are most easily examined by air contrast. Clear superiority in the diagnosis of peptic ulcers and peptic esophagitis has not been proved. The most accurate routine examination may be a multiphasic or combined approach utilizing air contrast views as well as filled compression views and careful fluoroscopy. With respect to the colon, we do not suggest that air contrast BE must be done exclusively. However, it is superior for the detection of polyps and small carcinomas. The technique should be available in all radiology departments and should be an integral part of the evaluation of patients at increased risk of developing carcinoma. This includes patients over 40 years of age, with chronic ulcerative colitis, familial multiple polyposis or Gardner's syndrome, family history of inherited cancer, and medical history of adenomatous polyps, colorectal cancer, or female genital cancer. In addition, air contrast enema should be utilized for the sensitive and accurate evaluation of early inflammatory bowel disease. Finally, with respect to the colon examination one fact must be stressed. Irregardless of full column or air contrast method, most missed lesions are due to poor bowel preparation, poor technique, or perceptive error by the radiologist. There can be no substitute for a clean colon, meticulous attention to technical details, and careful review of the radiographs.

Recently a patient with ulcerative colitis developed abdominal pain and a left upper quadrant mass. A 67Ga-citrate scintiscan showed increased activity over the mass. A barium enema demonstrated retrograde obstruction at the splenic flexure and intraluminal multilobulated tissue masses. The total abdominal colectomy specimen showed localized giant pseudopolyposis at the splenic flexure. This condition is a rare local complication of both ulcerative and granulomatous colitis. It resembles a villous adenoma on barium enema and, although inflammatory, may simulate a colonic carcinoma. When symptomatic, local resection may be sufficient treatment.

The medical literature and our own observations show the importance of x-ray examinations to diagnose colon carcinoma. The conventional barium enema examination without double contrast is not suitable for a general medical check-up. In contrast to the diagnostic value of the conventional procedure, the diagnostic accuracy of double contrast examination is comparable to that of the colonoscopy. In 1108 patients, endoscopically proven polyps smaller than 1 cm were detected in 61%, whereas the percentage for polyps bigger than 1 cm was 87. These results are achieved only in patients with a sufficient preparation. Two of 25 colorectal carcinomas were detected neither by endoscopy nor by the double contrast method.

Provided examination conditions are optimal, we are now able to detect changes of the wall of the colon from about 5 mm diameter upwards and thus to further clarify the diagnosis and to initiate appropriate treatment. Hence, the demand for early or timely diagnosis can be met by means of x-ray diagnosis in respect of processes of the colon.

Localized giant pseudo-polyposis is a rare complication of ulcerative or granulomatous colitis. A case illustrating the typical radiological findings is described. Recognition of this condition is important since it may simulate malignancy.

The single-contrast (SC), double-contrast (DC), and biphasic examinations of the sigmoid colon in 51 patients with histologically proved sigmoid polyps 1.0 cm or greater in diameter were reviewed. In each case the polyps were radiographically detected and visualized by endoscopy. The radiographs of 49 patients without sigmoid polyps were similarly reviewed. The biphasic approach was significantly superior to the single-contrast examination in the detection of sigmoid polyps (p less than 0.05). The differences between SC and DC examinations as well as between DC and biphasic examinations were not significant. In the presence of diverticulosis, however, the biphasic approach proved to be significantly more sensitive than the DC examination. The greater sensitivity of the biphasic examination compared with SC was of borderline significance. It is concluded that in the presence of diverticulosis a combination of single- and double-contrast techniques can improve the sensitivity of the examination significantly in the detection of polypoid lesions.

Seven hundred and forty-one colonic polyps have been removed by colonoscopic polypectomy during 300 examinations. Up to 36 polyps were removed at a single examination. Colonoscopic treatment of villous adenomas to 7 cm has been successfully performed in elderly and infirm patients. There were no deaths or incidents of perforation and the only significant complications were two secondary haemorrhages requiring transfusion. The presence of a polyp was not definitely reported in 40% of barium enema X-ray examinations carried out within three months of polypectomy. Double contrast X-ray examinations were significantly more sensitive in the detection of polyps. Colonoscopic polypectomy is a safe and effective technique. All colonic polyps should be removed by this technique after diagnosis.

Author's experience about 70 endoscopic polipectomy of high gastrointestinal tract, realized on 53 patients during 1978-1983 period was evaluated. Esophaguel polyps incidence was 0.06% among 7.900 endoscopic studies; gastric polyps was 0.8% and duodenal was 0.03%. Diagnosis was radiologically suspected in 58%. Gastric antrum was the predominant localization (45.7%) and macroscopic Yamada types IV (32.8%) and III (30.0%) were found more frequently. Most of patients presented solitary polips (86.7%). 63.2% of pieces were under 10 mm in size and 35.2% between 10 - 20 mm. High frecuency of adenomas (23.5%) and a low one of hyperplasiogenic (7.3%) was the prominent finding; only one case of early gastric cancer was founded (1.5%). Neither adenoms or hyperplasiogenic polyps were founded on gastric fundus, and no direct relation between size and histopatologic type was observed. Only one hemorragic complication (1.4%) was present. Polips incidence on 800 consecutive auptopsy protocols in adults was 0.12%.

A case is described in which massive development of pseudopolyps resulted in left colonic obstruction in a patient with a history of ulcerative colitis. Problems of diagnosis and management are discussed, with emphasis on the need for close radiographic and endoscopic follow-up of such patients.

A case of Cowden disease (multiple hamartoma syndrome) with marked gastrointestinal polyposis is presented. The differential diagnosis of gastrointestinal polyposis syndromes is discussed.

Twenty-four cases of duodenal adenomas which did not originate at the ampulla of Vater are discussed. The radiographic and clinical features of these lesions are presented together with a review of 120 cases previously reported in the literature. The role of barium studies and endoscopy in the evaluation of these adenomas is emphasized. A diameter of more than 5 cm represents a criterion favoring malignant degeneration of such non-Vaterian adenomas.

Diverse signs may be seen on barium enema in the various forms of colitis. Barium enema is only reasonably specific in the diagnosis of Crohn's disease and ulcerative colitis once the other possible diseases have been excluded from consideration by biopsy, microscopy, culture, or therapeutic trial. In particular, campylobacter colitis has proved to be such a common entity that many patients originally thought to have had one attack of ulcerative colitis, ischemic colitis, or Crohn's colitis may never have had these diseases. Many of the relatively specific signs can be seen in a variety of conditions. For example, aphthae in the colon may be seen in Crohn's disease, yersinia enterocolitis, Behçet's syndrome, amebiasis, ischemia, tuberculosis, and campylobacter colitis. Continuity of disease is characteristic in ulcerative colitis. Nevertheless, patches of healing may occur, so that a rare patient may be seen during a resolving attack of ulcerative colitis in whom only scattered patches of active disease can be seen on barium enema. In general, few radiologic signs on barium enema are truly specific for one disease, with penumatosis cystoides coli being an exception to this rule. However, the sensitivity of barium enema with currently available materials for double-contrast techniques is such that radiology continues to be useful at present in diagnosing the colitides and in managing patients.

There are many disease processes, both inflammatory and neoplastic, which can alter the colonic bowel wall. A retrospective study was done on surgically proven cases of colonic disease in which colonic bowel wall abnormalities were identified by computed tomography. Colonic bowel wall thickening was the most common finding, but was nonspecific. Finger-like projections extending from the bowel wall into the surrounding mesentery did help distinguish inflammatory change from neoplastic change. Examples of diverticulitis, appendicitis, Crohn's disease, carcinoma, lymphoma, and metastatic disease are presented.