Rattan N, Willmann L, Aston D, George S, Bassan M, Abi-Hanna D, Anandabaskaran S, Ermerak G, Ng W, Koo JH. To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy. World J Gastrointest Oncol 2022; 14(9): 1798-1807 [PMID: 36187395 DOI: 10.4251/wjgo.v14.i9.1798]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
There is currently minimal consensus to inform clinicians of the best approach to manage patients presenting with positive immunochemical fecal occult blood test (iFOBT) after having a recent colonoscopy. Repeating the colonoscopy within a short time frame may expose to the patient to unnecessary procedure-related risks, avoidable patient anxiety and a higher cost-burden on the healthcare system.
Research motivation
The primary motivation for this study was to determine the widest acceptable interval between consecutive colonoscopies that maintains patient safety through a reduction in colorectal cancer (CRC) incidence whilst optimizing healthcare resource utilization.
Research objectives
To determine the prevalence of CRC and advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.
Research methods
This study included iFOBT-positive patients who were referred for a colonoscopy at a high-volume Australian tertiary referral center. Data was prospectively collected including demographics, quality indicators and results of current and previous colonoscopy. The main outcome was to determine the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT who had a previous colonoscopy.
Research results
Of the 1051 patients included in the study, 319 (30.3%) had a previous colonoscopy. In this group, four patients were diagnosed with CRC. Among those who had a colonoscopy within four years, none were diagnosed with CRC and 7 had advanced adenomas/sessile serrated lesions. Of the 732 patients with no prior colonoscopy, there were 38 CRC (5.2%).
Research conclusions
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 CRC.
Research perspectives
Our study suggests that a colonoscopy could be deferred following a positive iFOBT result for patients who had a high-quality colonoscopy performed within 4 years. However, a colonoscopy should be repeated if there are concerns about the quality of the prior colonoscopy or presence of high-risk clinical features.
