Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1798
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
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.
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.
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.
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.
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%).
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.
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.