Colonoscopy for Positive Fecal Immunochemical Test Cannot Wait

Douglas K. Rex, MD, MASGE reviewing Mutneja HR, et al. J Gastroenterol Hepatol 2020 Dec 22.

Among 361,637 patients in 6 observational studies, delays in colonoscopy beyond 6 months after a positive fecal blood test were associated with an increased risk of developing advanced-stage colorectal cancer (CRC; odds ratio [OR], 2.16), any CRC (OR, 1.58), or advanced adenomas (OR, 1.17). There were no differences in these endpoints when cutoffs of 1, 2, or 3 months were used.

Comment:

Various guideline groups have recommended that patients with positive fecal immunochemical tests undergo colonoscopy within 1 or 2 months. These results demonstrate an impact on outcomes when colonoscopy is delayed more than 6 months, but important reductions in good outcomes could occur with shorter delays that did not reach significance here. The magnitude of the odds ratios suggests that a 6-month delay is a larger problem for cancer progressing to an advanced stage than for the development of cancer. In turn, this suggests that the progression from cancer to advanced cancer is faster than the progression from advanced adenoma to cancer, and both are faster than the transition from adenoma to advanced adenoma.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Mutneja HR, Bhurwal A, Arora S, Vohra I, Attar BM. A delay in colonoscopy after positive fecal tests leads to higher incidence of colorectal cancer: a systematic review and meta-analysis. J Gastroenterol Hepatol 2020 Dec 22. (Epub ahead of print) (https://doi.org/10.1111/jgh.15381)