To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy

Abstract

BACKGROUND Colorectal cancer (CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test (iFOBT), following a recent colonoscopy. AIM To determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia. METHODS The study recruited iFOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia. RESULTS The study included 1051 patients (male 53.6%; median age 63). Forty-two (4.0%) patients were diagnosed with CRC, 513 (48.8%) with adenoma/sessile serrated lesion (A-SSL) and 257 (24.5%) with advanced A-SSL (AA-SSL). A previous colonoscopy had been performed in 319 (30.3%). In this cohort, four (1.3%) were diagnosed with CRC, 146 (45.8%) with A-SSL and 56 (17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs (5.2%). Independent predictors for advanced neoplasia were male [odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.35-2.40; P < 0.001), age (OR = 1.04; 95%CI: 1.02-1.06; P < 0.001) and no previous colonoscopy (OR = 2.07; 95%CI: 1.49-2.87; P < 0.001). CONCLUSION A previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.

Is annual screening by fecal immunochemical test necessary after a recent colonoscopy?

“…Previous reports suggest that TCS should be repeated when there is concern about the quality of the previous TCS or in high‐risk patients, such as older age or family history of CRC. 17 In our study, the results of a previous TCS affected those of a TCS after a positive FIT result, and patients with previous AN, ≥3 adenomatous lesions, and size ≥10 mm showed higher ADR and AN detection rates in TCS after FIT. Reportedly, the results of a previous TCS can affect the results of surveillance TCS.…”

“…Several studies have reported the association between repeat colonoscopy for patients with positive FIT results and recent colonoscopy. 16 , 17 , 18 , 19 , 20 Kim et al. reported the results of TCS for patients aged ≥50 years with positive FIT results.…”

“…Another study group also analyzed patients aged ≥50 years with a positive FIT result and a recent TCS and reported that the AN detection rate was 10.3% among those who underwent TCS within 4 years. 17 They concluded that TCS within 4 years was protective against CRC because CRC was not found in those patients. Kawamura et al.…”