Detection of Colorectal Neoplasm in Patients with Positive Fecal Immunohistochemistry Test After Recent Colonoscopy

Abstract

Introduction: Recent recommendation, based on limited evidence, that patients who underwent colonoscopy followed by a positive Fecal Immunohistochemistry Test (FIT) should be offered a repeat colonoscopy before the individual would normally be due to a repeat endoscopic evaluation. The aim of this study is to explore whether there is evidence to suggest that repeat colonoscopy may be beneficial in such cases. Methods: Patients who had recently undergone colonoscopy screening at the Miami Veterans Affairs Medical Center who agreed to repeat colonoscopy following a subsequent positive FIT test result before the recommended screening/surveillance interval were evaluated prospectively. Results: Of a total of eighteen FIT positive patients, seven completed a repeat colonoscopy before the recommended screening interval. Two of seven patients manifested high risk adenomas. Cancer was not detected on repeat colonoscopy in any of these patients. Conclusion: No colorectal cancers were diagnosed in patients with a positive FIT result on repeat colonoscopy screening. Advanced colon adenomas, however, were identified in 28.5% of these patients. Although this study does not provide clear evidence of a benefit of repeat colonoscopy for these patients before the recommended screening interval, detection of high risk adenomas in some of them warrants further study with a significantly larger sample size.