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

Table 1 Patient demographics and current colonoscopy findings

n = 1051	Previous colonoscopy = Yes, n = 319 (30.4%)	Previous colonoscopy = No/unknown, n = 732 (69.6%)	P value
Sex
Male	174 (54.5%)	389 (53.1%)	0.68
Age
50-64	151 (47.3%)	438 (59.8%)	< 0.001
65 +	168 (52.7%)	294 (40.2%)
Median age	65 (range 50-75)	62 (range 50-75)	< 0.001
Family history of CRC
Yes	52 (16.3%)	56 (7.7%)	< 0.001
Symptomatic
Any symptoms	149 (46.7%)	258 (35.2%)	< 0.001
Rectal bleeding	66 (20.7%)	112 (15.3%)	0.03
Change in bowel pattern	65 (20.4%)	116 (15.8%)	0.09
Abdominal pain	35 (11%)	46 (6.3%)	0.014
Weight loss	11 (3.4%)	34 (4.6%)	0.28
Anemia	19 (6.0%)	40 (5.5%)	0.75
Current colonoscopy bowel preparation
Good/excellent	204 (63.9%)	532 (72.7%)	0.014
Poor	23 (7.2%)	46 (6.3%)
Complete colonoscopy	311 (97.5%)	715 (97.7%)	0.42
CRC detected	4 (1.3%)	38 (5.2%)	0.003
A-SSL detected	146 (45.8%)	367 (50.1%)	0.19
AA-SSL detected	57 (17.8%)	200 (27.3%)	0.002
Advanced neoplasia	60 (18.8%)	221 (30.2%)	< 0.001

CRC: Colorectal cancer; A-SSL: Adenoma/sessile serrated lesion; AA-SSL: Advanced adenoma/sessile serrated lesion.

Table 2 Time of previous colonoscopy in relation to current procedure

Time since previous colonoscopy; n = 319	Frequency (%)
< 1 yr	2 (0.6)
1-2 yr	11 (3.4)
2-3 yr	18 (5.6)
3-4 yr	37 (11.6)
4-5 yr	37 (11.6)
> 5 yr	204 (63.9)
Timing unknown	10 (3.1)

Table 3 Patients with colorectal cancer - previous and current colonoscopy findings

Patient	Gender	Age at current colonoscopy	Family history	Symptoms	Year of previous colonoscopy	Year of current colonoscopy	Quality of bowel preparation of previous colonoscopy	Quality of bowel preparation of current colonoscopy	Result of previous colonoscopy	Site of CRC	AJCC stage of CRC
1	Male	71	Nil	Nil	Oct 2012	May 2017	Good	Fair	Normal	Sigmoid colon	1
2	Male	59	Nil	Abdominal pain	2010	2017	Good	Good	Normal	Hepatic flexure	3B
3	Female	72	Nil	Nil	> 10 yr	2016	Unknown	Good	Unknown	Rectum	1
4	Female	72	Nil	Nil	> 10 yr	2019	Unknown	Good	Unknown	Cecum	1

CRC: Colorectal cancer; AJCC: American Joint Committee on Cancer.

Table 4 Diagnosis of advanced adenoma/sessile serrated lesion, advanced neoplasia and colorectal cancer as per time since previous colonoscopy

Total = 1051	Had a previous colonoscopy, n = 319				Never had or uncertain of previous colonoscopy, n = 732
	0-4 yr, (n = 68)	4-5 yr (n = 37)	> 5 yr (n = 204)	Unsure when (n = 10)	Never (n = 685)	Unsure (n = 47)
AA-SSL	7 (10.3%)	7 (18.9%)	41 (20.1%)	1 (10%)	181 (26.4%)	19 (40.4%)
Advanced neoplasia	7 (10.3%)	8 (21.6%)	44 (21.6%)	1 (10%)	202 (29.5%)	19 (40.4%)
CRC	0	1 (2.7%)	3 (1.5%)	0	37 (5.4%)	1 (2.1%)

AA-SSL: Advanced adenoma/sessile serrated lesion; CRC: Colorectal cancer.

Table 5 Patients with advanced adenoma/sessile serrated lesion - previous and current colonoscopy findings

Patient	Gender	Age at current colonoscopy	Family history	Symptoms	Year of previous colonoscopy	Year of current colonoscopy	Quality of bowel preparation of previous colonoscopy	Quality of bowel preparation of current colonoscopy	Result of previous colonoscopy	Most advanced histology on current colonoscopy	Size of largest polyp (mm)
1	Male	74	Nil	Altered bowel pattern, abdominal pain	2012	2015	Unknown	Fair	Melanosis coli	Serrated adenoma	13
2	Female	70	Nil	Abdominal pain	2015	2017	Good	Good	Angioectasia	Tubular adenoma with LGD	10
3	Male	74	Nil	Nil	2016	2019	Fair	Excellent	Tubular adenomas × 4	Tubulovillous adenoma with LGD	20
4	Male	75	Nil	Nil	2016	2017	Poor	Fair	Tubular adenoma × 1	Tubulovillous adenoma with LGD	15
5	Male	71	Nil	Nil	2015	2018	Poor	Good	Normal	Tubular adenoma with LGD	10
6	Male	70	Nil	Nil	2012	2015	Unknown	Good	Unknown	Tubular adenoma with LGD	10
7	Male	58	Nil	Nil	2015	2018	Unknown	Fair	Unknown	Tubular adenoma with LGD	10

LGD: Low-grade dysplasia.

Table 6 Univariate and multivariate analyses of predictors of advanced neoplasia in the entire cohort

Variable	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Gender: Male	1.78	1.34-2.36	< 0.001	1.80	1.35-2.40	< 0.001
Increasing age (continuous variable)	1.04	1.02-1.06	< 0.001	1.04	1.02-1.06	< 0.001
Family history of CRC	1.07	0.68-1.68	0.77	2.07	1.49-2.87	< 0.001
No previous colonoscopy	1.83	1.39-2.52	< 0.001
Aspirin use	0.96	0.58-1.60	0.89
Diabetes	0.81	0.52-1.26	0.36
Symptoms of CRC	0.90	0.68-1.19	0.65

CRC: Colorectal cancer; OR: Odds ratio; CI: Confidence interval.