Results of an extensive multiple-choice questionnaire sent to 175 leading medical centers in the world were analyzed and compared with those of a similar survey from 1976. One hundred sixty-two (93%) responses were received. Both single- and double-contrast enema procedures are still employed, but the use of the double-contrast technique has markedly increased. Preparation of the colon is even more meticulous than in 1976 and is equal for both techniques. Pharmacologic aids are used more often but preparatory enemas less frequently than in 1976. The use of fluoroscopic equipment has not significantly changed. The decision on the appropriate sequence for the barium enema examination and colonoscopy is based on the individual clinical problem in the majority of cases, and the time interval between the barium enema examination and lower endoscopy with or without biopsy is significantly shorter than in 1976. The use of computed tomography and magnetic resonance imaging has increased since 1976, but angiography is used less often and mostly for unknown causes of bleeding and to stop bleeding.