Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1798-1807
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1798
To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy
Nivedita Rattan, Laura Willmann, Diana Aston, Shani George, Milan Bassan, David Abi-Hanna, Sulakchanan Anandabaskaran, George Ermerak, Watson Ng, Jenn Hian Koo
Nivedita Rattan, Laura Willmann, Diana Aston, Shani George, Milan Bassan, David Abi-Hanna, Sulakchanan Anandabaskaran, George Ermerak, Watson Ng, Jenn Hian Koo, Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
Nivedita Rattan, Milan Bassan, George Ermerak, Watson Ng, Jenn Hian Koo, Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
Author contributions: Koo JH was the guarantor of the study; Koo JH, Bassan M, Abi-Hanna D, and Ng W designed the study; Rattan N, Willmann L, Aston D, George S, Anandabaskaran S, Ermerak G participated in the acquisition of the data; Koo JH, Rattan N, Willmann L and Ng W participated in the analysis and interpretation of the data; Rattan N drafted the initial manuscript; Koo JH, Bassan M, Abi-Hanna D and Ng W revised the article critically for important intellectual content; and all authors have read and approved the final manuscript.
Institutional review board statement: The local institution’s Human Research and Ethics Committee approved the study (HREC/LNR/15/LPOOL/186).
Informed consent statement: Informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of item.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jenn Hian Koo, FRACP, MBBS, PhD, Doctor, Gastroenterology and Liver Services, Liverpool Hospital, Elizabeth Street, Liverpool 2170, New South Wales, Australia. jenn.koo@health.nsw.gov.au
Received: January 21, 2022
Peer-review started: January 21, 2022
First decision: February 24, 2022
Revised: March 12, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: September 15, 2022
Processing time: 231 Days and 7.3 Hours
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.

Keywords: Colorectal cancer; Adenoma; Screening; Fecal occult blood test; Colonoscopy

Core Tip: Currently, there is minimal consensus to inform clinicians of the appropriate approach to manage patients presenting with positive immunochemical fecal occult blood test (iFOBT) following a recent colonoscopy. This may lead to additional unnecessary, invasive procedure which confers procedure-related risks, as well as avoidable patient anxiety and a higher cost-burden on the healthcare system. Our study revealed that a previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within 4 years of a positive iFOBT result, was protective against colorectal cancer.