Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies

“…Our search identified five potentially relevant studies. [113][114][115][116][117] These were four reviews [113][114][115][116] and one population-based study. 117 Two of the reviews, by Manta et al 115 and Church, 116 were overviews that did not include a systematic approach to searching literature; neither did these reviews include further analysis.…”

Section: Probability Of Adverse Events Associated With Colonoscopymentioning

confidence: 99%

“…117 Two of the reviews, by Manta et al 115 and Church, 116 were overviews that did not include a systematic approach to searching literature; neither did these reviews include further analysis. The two other reviews, by Reumkens et al 113 and Day et al, 114 were systematic literature reviews and both included a meta-analysis. The review by Day et al…”

Section: Probability Of Adverse Events Associated With Colonoscopymentioning

confidence: 99%

“…These were deemed to be of less relevance, as systematic literature reviews are preferred over single studies. Therefore, the study by Reumkens et al 113 was deemed to be the most appropriate study to populate the probability of adverse events due to colonoscopy in the diagnostic model. The adverse events included in the model are bowel bleeding, perforation and death.…”

Section: Probability Of Adverse Events Associated With Colonoscopymentioning

confidence: 99%

“…This was based on the study by Reumkens et al 113 To investigate the impact of this assumption on the cost-effectiveness results, we considered in this scenario the highest value that was found in the literature for the mortality due to colonoscopy; this was 0.0970% and it was reported by Day et al 114 for elderly patients undergoing colonoscopy. Additionally, we explored a scenario for which no adverse events (including mortality) were considered.…”

Section: Adverse Events Associated With Colonoscopymentioning

confidence: 99%

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Faecal immunochemical tests to triage patients with lower abdominal symptoms for suspected colorectal cancer referrals in primary care: a systematic review and cost-effectiveness analysis

Westwood

Ramos

Lang

et al. 2017

Health Technol Assess

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BackgroundColorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation.ObjectivesTo assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms.MethodsTwenty-four resources were searched to March 2016. Review methods followed published guidelines. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. The cost-effectiveness analysis considered long-term costs and quality-adjusted life-years (QALYs) that were associated with different faecal occult blood tests and direct colonoscopy referral. Modelling comprised a diagnostic decision model, a Markov model for long-term costs and QALYs that were associated with CRC treatment and progression, and a Markov model for QALYs that were associated with no CRC.ResultsWe included 10 studies. Using a single sample and 10 µg Hb/g faeces threshold, sensitivity estimates for OC-Sensor [92.1%, 95% confidence interval (CI) 86.9% to 95.3%] and HM-JACKarc (100%, 95% CI 71.5% to 100%) indicated that both may be useful to rule out CRC. Specificity estimates were 85.8% (95% CI 78.3% to 91.0%) and 76.6% (95% CI 72.6% to 80.3%). Triage using FITs could rule out CRC and avoid colonoscopy in approximately 75% of symptomatic patients. Data from our systematic review suggest that 22.5–93% of patients with a positive FIT and no CRC have other significant bowel pathologies. The results of the base-case analysis suggested minimal difference in QALYs between all of the strategies; no triage (referral straight to colonoscopy) is the most expensive. Faecal immunochemical testing was cost-effective (cheaper and more, or only slightly less, effective) compared with no triage. Faecal immunochemical testing was more effective and costly than guaiac faecal occult blood testing, but remained cost-effective at a threshold incremental cost-effectiveness ratio of £30,000. The results of scenario analyses did not differ substantively from the base-case. Results were better for faecal immunochemical testing when accuracy of the guaiac faecal occult blood test (gFOBT) was based on studies that were more representative of the correct population.LimitationsOnly one included study evaluated faecal immunochemical testing in primary care; however, all of the other studies evaluated faecal immunochemical testing at the point of referral. Further, validation data for the Faecal haemoglobin, Age and Sex Test (FAST) score, which includes faecal immunochemical testing, showed no significant difference in performance between primary and secondary care. There were insufficient data to adequately assess FOB Gold, RIDASCREEN Hb or RIDASCREEN Hb/Hp complex. No study compared FIT assays, or FIT assays versus gFOBT; all of the data included in this assessment refer to the clinical effectiveness of individual FIT methods andnottheir comparative effectiveness.ConclusionsFaecal immunochemical testing is likely to be a clinically effective and cost-effective strategy for triaging people who are presenting, in primary care settings, with lower abdominal symptoms and who are at low risk for CRC. Further research is required to confirm the effectiveness of faecal immunochemical testing in primary care practice and to compare the performance of different FIT assays.Study registrationThis study is registered as PROSPERO CRD42016037723.FundingThe National Institute for Health Research Health Technology Assessment programme.

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