In Reply.—Ott et al properly place emphasis on the quality of the barium enema (BE) and colonoscopic examinations. It is difficult to assess relative skills in these two different disciplines, and I am in no position to make this comparison from our study. However, Tedesco and colleagues1 did a prospective double-blind study for both BE and colonoscopy in chronic gastrointestinal bleeding in which the examinations were done by gastrointestinal and radiological fellows at similar levels of training and experience. The findings from this study (in which BE missed four of 12 cancers) were very similar to ours (in which barium enema missed three of 11 cancers).
Ott and associates state that colonoscopy is three to four times more expensive than BE. This drawback to colonoscopy was addressed in our article, including steps that may be taken to make colonoscopy equally cost-effective with BE in the evaluation of chronic