Bad Outcomes for Patients Not Undergoing Colonoscopy After Positive Fecal Immunochemical Test

Douglas K. Rex, MD, MASGE reviewing Zorzi M, et al. Gut 2021 Mar 31.

In an Italian study using a fecal immunochemical test (FIT)-positivity cutoff of 20 µg Hb/g feces, 88,013 FIT-positive patients (79%) underwent colonoscopy, and 23,410 (21%) did not. The 10-year cumulative incidence of colorectal cancer (CRC) was 44.7 per 1000 among colonoscopy compliers and 54.3 per 1000 in noncompliers. CRC mortality in compliers was 6.8 per 1000, whereas in noncompliers, it was 16.0 per 1000, a rate that was 103% higher than that in the colonoscopy compliers. The fraction of CRC diagnosed less than 1 year after a positive FIT was 90.1% in compliers and 62.9% in noncompliers (P<.0001). All-cause mortality was 83.4 per 1000 in compliers and 164.2 per 1000 in noncompliers.


The higher all-cause mortality in noncompliers suggests that noncompliance with colonoscopy after a positive FIT is a marker for poor health and risk of death.

The 79% compliance rate is high and near the 80% minimum quality threshold set by the U.S. Multi-Society Task Force on Colorectal Cancer. Despite that, we have seen recent studies from the U.S. that report achieving less than 50% compliance with colonoscopy after a positive FIT. In an organized screening program, navigation of the process for completing colonoscopy in FIT-positive patients seems mandatory.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Zorzi M, Battagello J, Selby K, et al. Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer. Gut 2021 Mar 31. (Epub ahead of print) (