PURPOSE: To determine the efficiency of CT colonography (CTC), as compared with the double contrast barium enema (DCBE) for the preoperative work-up of colorectal neoplasms. MATERIALS AND METHODS: A total of 39 patients underwent both a CTC and DCBE before surgery. Three abdominal radiologists and three colorectal surgeons retrospectively reviewed virtual double contrast (VDC) and DCBE images, regarding each examination for localization, conspicuity, extent and morphology of neoplasms. We reviewed the radiological reports of the CTC and DCBE for the polyps. RESULTS: In the case of both VDC and DCBE, 40 cancers were detected in 39 patients. According to abdominal radiologists, VDC showed the same ability to identify DCBE for localization of neoplasms (p < 0.001). However, DCBE was significantly superior or equal to the VDC (p < 0.05) in conspicuity, extent, and morphology of the main mass. According to colorectal surgeons, VDC was significantly superior or equal to DCBE for all parameters (each p < 0.05). The ability to detect polyps was not significantly different between the CTC and DCBE (p > 0.05). CONCLUSION: The performance of the CTC is comparable to the DCBE for the localization of main mass and polyps in patients with colorectal neoplasm. Barium enema don't seem to be necessary for patients who undergo a CTC as preoperative work-up.