Faecal Haemoglobin Concentration As a Predictor of Colorectal Neoplasia in Patients at Moderate to High Risk of Colorectal Cancer Attending for Surveillance Colonoscopy

2019 ◽  
Author(s):  
Jayne Digby ◽  
Shirley Cleary ◽  
Lynne Gray ◽  
Pooja Datt ◽  
David R Goudie ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Colorectal Neoplasia ◽  
Haemoglobin Concentration ◽  
Surveillance Colonoscopy

scholarly journals Faecal haemoglobin can define risk of colorectal neoplasia at surveillance colonoscopy in patients at increased risk of colorectal cancer

2020 ◽  
Vol 8 (5) ◽  
pp. 559-566
Author(s):  
Jayne Digby ◽  
Shirley Cleary ◽  
Lynne Gray ◽  
Pooja Datt ◽  
David R Goudie ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Diagnostic Accuracy ◽  
Limit Of Detection ◽  
Colorectal Neoplasia ◽  
Haemoglobin Concentration ◽  
Surveillance Colonoscopy ◽  
National Guidelines ◽  
Predictive Values ◽  
Advanced Neoplasia ◽  
Increased Risk

Background Quantitative faecal immunochemical tests measure faecal haemoglobin concentration (f-Hb), which increases in the presence of colorectal neoplasia. Objective We examined the diagnostic accuracy of faecal immunochemical test (FIT)in patients at increased risk of colorectal cancer (CRC) attending for surveillance colonoscopy as per national guidelines. Methods A total of 1103 consecutive patients were prospectively invited to complete a FIT before their scheduled colonoscopy in two university hospitals in 2014– 2016. F-Hb was analysed on an OC-Sensor io automated analyser (Eiken Chemical Co., Ltd, Tokyo, Japan) with a limit of detection of 2 µg Hb/g faeces. The diagnostic accuracy of f-Hb for CRC and higher-risk adenoma was examined. Results A total of 643 patients returned a faecal test. After excluding 4 patients with known inflammatory bowel disease, 639 (57.9%) remained in the study: age range: 25–90 years (median: 64 years, interquartile range (IQR): 55–71): 54.6% male. Of 593 patients who also completed colonoscopy, 41 (6.9%) had advanced neoplasia (4 CRC, 37 higher-risk adenoma). Of the 238 patients (40.1%) who had detectable f-Hb, 31 (13.0%) had advanced neoplasia (2 CRC, 29 higher-risk adenoma) compared with 10 (2.8%) in those with undetectable f-Hb (2 CRC, 8 higher-risk adenoma). Detectable f-Hb gave negative predictive values of 99.4% for CRC and 97.2% for CRC plus higher-risk adenoma. Conclusion In patients at increased risk of CRC under colonoscopy surveillance, a test measuring faecal haemoglobin can provide an objective estimate of the risk of advanced neoplasia, and could enable tailored scheduling of colonoscopy.

scholarly journals Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study

Gut ◽  
2018 ◽  
Vol 68 (4) ◽  
pp. 615-622 ◽  
Author(s):  
Joren R ten Hove ◽  
Shailja C Shah ◽  
Seth R Shaffer ◽  
Charles N Bernstein ◽  
Daniel Castaneda ◽  
...  
Keyword(s):  
High Risk ◽  
Colorectal Neoplasia ◽  
Low Risk ◽  
Surveillance Colonoscopy ◽  
Time Intervals ◽  
Index Procedure ◽  
Advanced Colorectal Neoplasia ◽  
Negative Findings ◽  
Inflammatory Bowel

ObjectivesSurveillance colonoscopy is thought to prevent colorectal cancer (CRC) in patients with long-standing colonic IBD, but data regarding the frequency of surveillance and the findings thereof are lacking. Our aim was to determine whether consecutive negative surveillance colonoscopies adequately predict low neoplastic risk.DesignA multicentre, multinational database of patients with long-standing IBD colitis without high-risk features and undergoing regular CRC surveillance was constructed. A ‘negative’ surveillance colonoscopy was predefined as a technically adequate procedure having no postinflammatory polyps, no strictures, no endoscopic disease activity and no evidence of neoplasia; a ‘positive’ colonoscopy was a technically adequate procedure that included at least one of these criteria. The primary endpoint was advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia or CRC.ResultsOf 775 patients with long-standing IBD colitis, 44% (n=340) had >1 negative colonoscopy. Patients with consecutive negative surveillance colonoscopies were compared with those who had at least one positive colonoscopy. Both groups had similar demographics, disease-related characteristics, number of surveillance colonoscopies and time intervals between colonoscopies. No aCRN occurred in those with consecutive negative surveillance, compared with an incidence rate of 0.29 to 0.76/100 patient-years (P=0.02) in those having >1 positive colonoscopy on follow-up of 6.1 (P25–P75: 4.6–8.2) years after the index procedure.ConclusionWithin this large surveillance cohort of patients with colonic IBD and no additional high-risk features, having two consecutive negative colonoscopies predicted a very low risk of aCRN occurrence on follow-up. Our findings suggest that longer surveillance intervals in this selected population may be safe.

Prevalence of advanced colorectal neoplasia according to risk categories at screening colonoscopy in a tertiary referral center.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 578-578
Author(s):  
Eduardo Negrete Carballo ◽  
Fidel David Huitzil Melendez
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Colorectal Neoplasia ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Moderate Risk ◽  
Advanced Colorectal Neoplasia ◽  
Advanced Neoplasm ◽  
Colorectal Screening

578 Background: Colorectal cancer (CRC) is the third most common cancer in the world. There is strong evidence that screening for colorectal cancer improves survival in conutries with high incidence. Although Mexico is considered a country with a low incidence of CRC, 4694 potentially preventable deaths occur every year. There is no established CRC screening program in our country, risk stratification of the target populations to be screened may bring potential advantages, making the strategy more cost-effective. The Asia-Pacific Colorectal Screening (APCS) score, is a validated risk-stratification tool that helps identify individuals at risk for advanced colorectal neoplasm amongst the asymptomatic population. Methods: We performed a retrospective, cross-sectional analysis of database records from 1172 patients who underwent screening colonoscopy betwen january 2013 and november 2014. Results: The prevalence of advanced colorectal neoplasia was 2.9%. Applying the APCS stratification, 91 subjects (7.8%) were in the average risk tier, 849 subjects (72.4%) in the moderate risk tier and 232 (19.8%) subjects in the high risk tier. The prevalence of advanced neoplasia in the average risk, moderate risk and high risk groups was 0%, 2.6% and 5.1%, respectively. The subjects in the high risk tier had 2.21-fold (p = 0.021) increased prevalence of advanced neoplasia than those in the average-moderate tier. Conclusions: The APCS score is a simple risk stratification index for colorectal advanced neoplasm that uses elementary clinical information on age, gender, family history and smoking to stratify the risk of colorectal advanced neoplasm in asymptomatic subjects for priority of colorectal screening.

scholarly journals Motion - Colonoscopic Surveillance is more Cost Effective than Colectomy in Patients with Ulcerative Colitis: Arguments Against the Motion

2003 ◽  
Vol 17 (2) ◽  
pp. 122-124 ◽  
Author(s):  
Anders Ekbom
Keyword(s):  
Colorectal Cancer ◽  
Ulcerative Colitis ◽  
High Risk ◽  
Positive Family History ◽  
Case Series ◽  
Good Alternative ◽  
Surveillance Colonoscopy ◽  
Colonoscopic Surveillance ◽  
Prophylactic Colectomy ◽  
Surveillance Programs

There are insufficient data upon which to base recommendations about surveillance colonoscopy and prophylactic colectomy for the prevention of colorectal cancer in patients with ulcerative colitis. Case series, analyses of intermediate results and extrapolations from other patient groups do not constitute reliable evidence. Available studies are susceptible to several biases: the ’healthy worker’ effect, surveillance bias and selection bias. Patients who are enrolled in surveillance programs are more likely to be thoroughly evaluated beforehand, are more likely to be given a diagnosis of dysplasia or neoplasm even when asymptomatic and are more likely to comply with medical treatment, including maintenance anti-inflammatory medication. Comparisons of the rates of neoplasia or death between surveyed and nonsurveyed patients are, therefore, of questionable validity. Prophylactic colectomy, unlike surveillance colonoscopy, prevents death from colorectal cancer. Moreover, it is difficult to keep patients in surveillance programs, and those who withdraw from programs appear to be at high risk of developing cancer. Prophylactic colectomy should be strongly considered for patients with dysplasia, sclerosing cholangitis, longstanding pancolitis (especially if it began early in life) or a positive family history of colorectal cancer. This procedure is underused in clinical practice and is a good alternative to colonoscopic surveillance in high risk patients.

scholarly journals Faecal haemoglobin concentration is related to detection of advanced colorectal neoplasia in the next screening round

2016 ◽  
Vol 24 (2) ◽  
pp. 62-68 ◽  
Author(s):  
Jayne Digby ◽  
Callum G Fraser ◽  
Francis A Carey ◽  
Robert H Diament ◽  
Margaret Balsitis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
Colorectal Neoplasia ◽  
Haemoglobin Concentration ◽  
Advanced Neoplasia ◽  
Negative Results ◽  
Adenoma Detection ◽  
Advanced Colorectal Neoplasia ◽  
Positive Results ◽  
Diagnostic Outcomes

Objective To examine associations between faecal haemoglobin concentrations below the cut-off used in colorectal cancer screening and outcomes in the next screening round. Methods In the Scottish Bowel Screening Programme, faecal haemoglobin concentrations and diagnostic outcomes were investigated for participants with a negative result (faecal haemoglobin concentrations < 80.0 µg Hb/g faeces), followed by a positive result within two years. Results Of 37,780 participants with negative results, at the next screening round, 556 (1.5%) screened positive and 30,293 (80.2%) negative. Initial median faecal haemoglobin concentrations (2.1 µg Hb/g faeces, IQR: 0.0–13.2) were higher in those with subsequent positive results than those with subsequent negative results (0.0 µg Hb/g faeces, IQR: 0.0–1.4; p < 0.0001). Using faecal haemoglobin concentrations 0.0–19.9 µg Hb/g faeces as reference, logistic regression analysis showed high adjusted odds ratios for advanced neoplasia (advanced neoplasia: colorectal cancer or higher risk adenoma) detection at the next round of 14.3 (95% CI: 8.9–23.1) in those with initial faecal haemoglobin concentrations 20.0–39.9 µg Hb/g faeces, and 38.0 (95% CI: 20.2–71.2) with 60.0–79.9 µg Hb/g faeces. Conclusions A higher proportion of participants with faecal haemoglobin concentrations of ≥ 20 µg Hb/g faeces had advanced neoplasia detected at the next round than participants with lower faecal haemoglobin concentrations. Although most relevant when using high faecal haemoglobin concentrations cut-offs, studies of faecal haemoglobin concentrations and outcomes over screening rounds may provide strategies to direct available colonoscopy towards those at highest risk.

Surveillance Colonoscopy Is Cost-Effective for Patients With Adenomas Who Are at High Risk of Colorectal Cancer

2010 ◽  
Vol 138 (7) ◽  
pp. 2292-2299.e1 ◽  
Author(s):  
Sameer D. Saini ◽  
Philip Schoenfeld ◽  
Sandeep Vijan
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Cost Effective ◽  
Surveillance Colonoscopy

scholarly journals Yield and Efficiency of FIT Tests Alone vs. In Combination with Risk Factors for Colorectal Cancer Screening

2020 ◽  
Vol 3 ◽  
Author(s):  
Vasu Sheel ◽  
Leslie Azzis ◽  
Racehl Hinrichs ◽  
Thomas Imperiale
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
High Risk ◽  
Colorectal Neoplasia ◽  
Risk Groups ◽  
Fiscal Year ◽  
Advanced Colorectal Neoplasia ◽  
Immunochemical Test ◽  
Advanced Adenomas

Background: Although colonoscopy (CY) may be considered the best screening test for colorectal cancer (CRC), annual fecal immunochemical test (FIT), which quantifies fecal hemoglobin is a viable alternative. Countries and healthcare systems using FIT-based screening may need to prioritize which FIT positive persons requires CY sooner (e.g. within the same fiscal year). We conducted a systematic review of published literature to understand how the yield/positive predictive value (PPV) of FIT could be improved.   Study Design: We performed a search of electronic databases for articles published between 2015 and June 2020. Titles, abstracts, and full texts were independently screened. Included studies fulfilled predetermined criteria and had descriptive and quantitative data extracted. We identified studies comparing the yield of FIT for advanced colorectal neoplasia ([AN], CRC plus advanced adenomas) among FIT positive persons to the yield of AN when FIT is combined with risk factors (age, sex, BMI, etc.). Data were extracted to find yield and efficiency of FIT alone vs FIT plus risk factors among FIT positive persons.   Results: From 623 titles reviewed, 4 studies met inclusion criteria. The objective of the studies was to increase the yield of AN or CRC in FIT positive patients. The number needed to scope (NNS) among FIT positives to detect AN significantly decreased for each study when looking at high risk groups as yield/PPV increased. The yield with FIT alone ranged from 24% to 46% and the NNS from 2.2 to 4.1. With risk factors, yield and NNS among those at high risk were 33.2 % to 75.6% and from 1.3 to 3.0, respectively.  Conclusion and Potential Impact: This systematic review quantifies how risk factors improve the yield for AN in FIT positive persons, which is information required for countries and health care settings with limited resources that need to direct CY resources to FIT positive patients at high risk for AN.  

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