Positive Fecal Occult Blood Test Research Articles

Laparoscopic sigmoid colectomy for transverse colonic varices due to an inferior mesenteric arteriovenous fistula

BackgroundColonic varices are a rare gastrointestinal anomaly often associated with portal hypertension. Arteriovenous fistula (AVF) in the inferior mesenteric artery (IMA) region is even rarer. Diagnosis and treatment of these entities present unique challenges, especially when the IMA is involved.Case presentationA 48-year-old man with a history of cholecystectomy presented with after a positive fecal occult blood test. Investigations revealed varices from the splenic flexure to the transverse colon and suspected AVF in the IMA region. Given the high risk and low efficacy of endoscopic and radiological interventions, laparoscopic sigmoidectomy was performed. This surgical approach successfully addressed both the AVF and the associated varices.ConclusionThis case underscores the importance of surgical intervention for AVF and colonic varices in the IMA region, particularly when other treatment options pose high risks and have limited efficacy. The favorable postoperative outcome in this case highlights the effectiveness of carefully chosen surgical methods when managing such complex and rare conditions.

Screening for colorectal cancer: Study on the shedding cells of feces

Objective: The objective of this study was to explore the enrichment efficiency of an improved fecal exfoliated cell enrichment method and its application in colorectal cancer screening. Material and Methods: Samples were collected from a cohort of 100 colorectal cancer patients being treated at the First Hospital of Hebei Medical University from January 2021 to June 2022. Patient samples were equally divided between control and experimental groups corresponding to the enrichment method being applied to the fecal exfoliated cells. Samples consisted of natural stool and bowel cleansing enema solution samples. The control group received the traditional three-layer integrated screen method, and the experimental group used nano-Fe3O4 folic acid magnetic beads to enrich the fecal exfoliated cells. The morphology of the extracted cells was observed by light microscopy through hematoxylin and eosin staining, and the positive rate of fecal occult blood test (FOBT) and the detection rate of colorectal cancer was compared between the two groups. Results: The FOBT-positive rates of natural feces and intestinal cleansing liquid in the control group were 74.00% and 90.00%, respectively, and the FOBT-positive rates of natural feces and intestinal cleansing liquid in the experimental group were 76.00% and 92.00%, respectively. The positive FOBT rate was high, and the difference was statistically significant (P = 0.037 and P = 0.029). The sensitivities of natural fecal exfoliation cytology in the control and experimental groups were 82.00% and 92.00%, respectively. The sensitivity of the experimental group was higher than that of the control group, and the difference was not statistically significant (P = 0.137). The sensitivities of the exfoliated cytology examination of the intestinal cleansing liquid in the control and experimental groups were 88.00% and 98.00%, respectively. The sensitivity of the experimental group was significantly higher than that of the control group, and the difference was statistically significant (P = 0.050). Cell smear results show that the exfoliated cells collected by the three-layer integrated sieve method are unevenly distributed, with overlapping cells and a large number of impurities blurring the background, seriously affecting the observation of cell morphology. The cell structure is blurred, stained unevenly, and arranged in a disorderly manner. The exfoliated cells collected by the nanofolic acid magnetic bead enrichment method are relatively evenly distributed, with no overlapping of cells in patches. The background is clear, and the morphology of each cell can be clearly observed. The cell structure is relatively clear, stained evenly, and distributed evenly. Conclusion: In the cytological examination of fecal exfoliation of colorectal cancer, the nano-Fe3O4 folic acid magnetic bead enrichment method can enrich more target cells compared with the traditional three-layer integrated screen method, improve the detection rate of colorectal cancer, and ensure the exfoliation The cell smears are of higher quality, providing a better sample for clinical assessment of the exfoliated cells. Nano-Fe3O4 folic acid magnetic beads enrichment method can become a simple, efficient, and relatively safe screening method for colorectal cancer, positively affecting early screening developments and diagnosis of colorectal cancer.

Abstract 2317: Development and validation of a colorectal cancer prediction model: A nationwide cohort-based study

Abstract Background: Colorectal cancer (CRC) ranks as the third most prevalent cancer globally and is a major cause of cancer-related mortality. Early diagnosis is critical to increase survival rates. While CRC screening has shown significant benefit, adherence remains low, and there is a need for better tools to identify high-risk patients. Risk prediction models were demonstrated to identify such patients. Aim: To establish an individualized risk prediction model for CRC diagnosis based on Electronic Health Records (EHR). Methods: This is a retrospective cohort study utilizing EHR data of Clalit Health Services (CHS) members aged 50-74 that were eligible for CRC screening, from January 2013 to January 2019. The model was trained to predict CRC diagnosis within two years using approximately 20,000 EHR features including socio-demographic information, laboratory results and medical history. Model performance, as a complementary screening method, was evaluated. Results: The study included 2679 subjects with CRC diagnosis and 1,133,713 subjects without CRC diagnosis. The model was trained on subjects from 2013-2017, and performance was validated on subjects from 2019 and a cohort of subjects that underwent fecal occult blood test (FOBT). Incidence values of CRC among subjects in the top 1% risk scores were higher than baseline (2.3% vs. 0.3%; lift 8.38; P-value <0.001). Characteristics of subjects by risk scores percentiles are presented in Table 1. Cumulative event probabilities increased with higher model scores, indicating a correlation between predicted and actual risk of CRC diagnosis. Model-based risk stratification among subjects with a positive FOBT, identified subjects with more than twice the risk for CRC compared to FOBT alone. Conclusions: We developed an individualized risk prediction model for CRC that can be utilized as a complementary decision support tool for healthcare providers to precisely identify patients at high risk for CRC and refer them to confirmatory testing. Citation Format: Samah Hayek. Development and validation of a colorectal cancer prediction model: A nationwide cohort-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2317.

Colorectal cancer screening; colonoscopy and biopsy results in people undergoing colonoscopy due to positive fecal occult blood test

Objective: Screening programs are important for the early detection of colorectal cancer, which is one of the causes of high morbidity and mortality. In this study, we investigated the colonoscopy results, the incidence of adenoma and cancer, and the relationship between test results and cancer in individuals with a positive fecal occult blood test for colorectal cancer screening. Material and Methods: Within the scope of the colorectal cancer screening program, colonoscopy was requested for individuals aged 50-70 years who applied to our outpatient clinic with a positive fecal occult blood test. The results were collected and analyzed. Results: The results of the colonoscopy could be obtained in only 237 (56.43%) of the 420 patients who were referred for a colonoscopy because of a positive fecal occult blood test. Colonoscopy results were normal in 15 (6.33%), benign anal disease in 64 (27%), benign colonic disease in 12 (5.06%) and polyp + adenocarcinoma in 146 (61.61%). Pathology results were benign polyp in 37 (15.61%), adenomatous polyp in 86 (36.29%) and adenocarcinoma in 23 (9.71%). Quantitative test results were higher in the adenomatous polyp + adenocarcinoma group and statistically significant (p= 0.03). Conclusion: Individuals with positive fecal occult blood tests, especially those with high quantitative test results, should be encouraged to have a colonoscopy, and they should be warned about the high probability of adenomatous polyps and colorectal cancer.

A108 AN EVALUATION OF IMPLEMENTATION OF A CENTRALIZED REFERRAL AND BOOKING PROCESS ON WAIT TIMES FOR COLONOSCOPIES

Abstract Background Colonoscopies in the majority of centres in Ontario are booked by individual endoscopists via their individual offices (practices). As such, wait times for procedures will vary significant from centre to centre, or even from endoscopist to endoscopist at the same centre, depending on individual expertise, experience, procedure types, and local availability of endoscopic resources. This system could lead to significant variability in access to care for patients. Aims This study analyzed the effect of implementing a centralized referral and booking process for colonoscopy, for a specific indication, at a single centre in Ontario. Methods This was a single centre retrospective study analyzing wait times for patients that underwent a colonoscopy at Cambridge Memorial Hospital (CMH) between April 2017 to July 2022 for either positive fecal occult blood test (FOBT) or fecal immunochemistry test (FIT). The province of Ontario transitioned from FOBT to FIT as the primary tool for colon cancer screening in 2019. Prior to this transition, colonoscopy for positive FOBT performed at CMH were booked by individual endoscopists, with wait times from referral to procedure having great variability. In conjunction with Ontario’s transition to FIT for colon cancer screening, all endoscopists at CMH agreed to participate in a centralized referral and booking process specifically for colonoscopy for positive FIT indication. A chart review of all patients undergoing colonoscopy for either FOBT (non central booking) or FIT (central booking). Patients that self-delayed were excluded. Wait times (WT) was calculated as time between date of referral and date of procedure. The effect of the centralized booking system on wait times was then assessed using statistical analysis. Results In total, 344 patients were included for analysis from before March 2019 (non centralized booking process). The average WT in this group was determined to be 99.2 days (range 50-171 days), of which 147 patients had a WT of less than 56 days (42.7%). In contrast, a total 572 patients were included for analysis after March 2019 (centralized booking process), the average WT was determined to be 44.2 days (range 32-59 days), of which, 526 patients had a WT of less than 56 days (92.0%). The centralized booking process reduced average wait times by 55 days (55.4%), and improved procedure WTs meeting mandated time frame of 56 days by 49.3%. This improvement in wait times was most pronounced for endoscopists with the longest wait times in a non centralized system. Conclusions The implementation of a centralized referral and booking process (for a single indication for colonoscopy) was associated with significantly reduced WTs. These findings suggest a centralized referral and booking process (for well defined clinical needs) can potentially significantly improve patient wait times. Funding Agencies None

Colonic diverticulosis as an isolated colonoscopy finding for iFOBT-positive patients

Colonic diverticular disease is a common medical condition throughout the world. It is one of the most common findings during the endoscopic evaluation of the colon, such as colonoscopy. A retrospective cohort single-centre study was carried out for all patients referred for colonoscopy with positive immunochemical faecal occult blood test (iFOBT) results in 2016-2018, mostly within The National Bower Cancer Screening Program (NBCSP) in QLD, Australia. The cohort of 319 patients were isolated from all iFOBT-positive individuals with such finding as a diverticular disease. Colonic diverticulosis affected the patients above 43 years old with positive iFOBT, more males than females in this study. In most cases, colonoscopy consisted of benign findings, and diverticular disease was revealed in 47.7% of the patients with such indication for colonoscopy as positive iFOBT. 28.8% of the patients were diagnosed with colonic diverticulosis only. The sigmoid colon was affected by diverticulosis in 96.2% of the cases. Overall, the colorectal cancer (CRC) diagnosis rate of 2.7% for the patients in the positive FOBT cohort (Group A) is comparable with other studies. However, the diverticulosis group's CRC rate of 1.6% (Group B) was lower than in available published data.

Rectally obtained fecal samples can be used for fecal occult blood testing in dogs, and fecal immunochemical tests do not detect canine or feline blood.

The first objective was to determine if the sample collection method (naturally voided vs digital rectal examination collection) affected fecal occult blood test (FOBT) results. The second objective was to assess the ability of human fecal hemoglobin immunochemical tests to detect canine and feline blood. 308 privately owned dogs, healthy and sick. Guaiac FOBTs were performed on paired voided and rectally obtained canine fecal samples. The kappa statistic was used to assess agreement between the 2 collection methods, and a multivariate regression model was used to identify factors associated with a positive FOBT. Two fecal immunochemical tests (FITs; Hemosure One Step and OC-Light S) were tested with serially diluted human, canine, and feline blood. Voided and rectally obtained samples showed strong FOB-positivity agreement (k = 0.80), with 92.5% concordance and only 13/308 dogs negative on void but positive on rectal. Multivariate analysis showed dogs with gastrointestinal disease (P = .0008, rectal; P = .0001, void) were more likely and heavier dogs (P = .0037, rectal; P = .0022 void) were less likely to test FOBT positive. Health status, fasting status, NSAID use, and age were associated with FOBT results on univariate, but not multivariate, analysis. FITs did not detect canine or feline blood at any concentration while human blood performed as expected. Rectally obtained fecal samples can be reliably used for FOBTs. Human FITs may not be suitable for companion animals, but evaluation of other available tests is needed.

Circulating tumor DNA (ctDNA) positivity and its association with clinicopathological characteristics by novel blood-based test for colorectal cancer (CRC) screening from a multi-center large cohort: COSMOS-CRC-01.

69 Background: Blood-based CRC screening has yielded performance comparable to stool-based screening tests and may be a modality that addresses the adherence gap in CRC screening. To investigate the diagnostic performance and its clinical relevance, we evaluated the test performance of a blood-based CRC screening test in a large cohort of individuals enriched for advanced colorectal neoplasia and early CRCs. Methods: 501 individuals presenting to ten institutions in Japan from 2020 to 2021 for treatment of advanced adenomas (AAs) or CRCs were consented and provided a pre-treatment blood sample (40mL whole blood in Streck cfDNA blood collection tubes). All eligible individuals underwent surgery or endoscopic resection within 30 days after sample collection and the pathological specimens were reviewed to determine cancer histology and stage, as well as AA histology. Pre-treatment blood samples were analyzed with a multi-modal (genomic and epigenomic) cfDNA CRC detection assay (Shield, Guardant Health, USA). Final cfDNA results were correlated with clinical data to determine the association of clinicopathological characteristics with test sensitivity. This study is registered as a clinical trial under UMIN000037765. Results: 451/501 (90%) individuals met inclusion/exclusion criteria and provided adequate blood samples that passed testing quality control criteria. Median age at consent was 67.4 years (range 31 – 92). 44% were female. 214/451 (47%) had a prior positive fecal occult blood test (FOBT). Of individuals with a negative or unknown FOBT testing, 161/237 (68%) had GI symptoms (e.g. abdominal pain, bloody/narrowing stool, constipation/diarrhea). The test identified 88% (268/305) of CRCs, including 71% (79/111) Stage I, 98% (87/89) Stage II, 97% (90/93) Stage III, and 100% (12/12) Stage IV. Overall sensitivity in detecting Stage I-III was 87%. The test identified 37% (54/146) of AAs, including 49% (33/68) of carcinoma in situs and 24% (9/37) of AAs with high-grade dysplasia. Sensitivity for right-sided CRC was 84% (61/73), 87% (59/68) for left-sided CRC, and 90% (148/164) for rectal tumors. Stage I test sensitivity was significantly associated with tumor size (>20mm; p<0.01), left-sided or rectal tumor location (p<0.05), and tumor depth (p<0.01) in univariate analysis, whereas the tumor depth (T2) was the sole factor associated with test positivity (p<0.05) in multivariate analysis. Specificity on this assay is 90% as determined in the ECLIPSE clinical study (NCT04136002). Conclusions: This study evaluates the performance of a blood-based test for CRC and its clinicopathological relevance in a large-scale cohort. In this population enriched for early colorectal neoplasia, the sensitivity was 88% for CRC and 37% for AAs. This performance is consistent with previous reports. Clinical trial information: UMIN000037765 .

Asymptomatic intestinal tuberculosis of the terminal ileum diagnosed on colonoscopy: a case report and literature review.

Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis. An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test. Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions. Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Evaluation of the positivity of the fecal occult blood test compared to the microscopic detection of red blood cells

Backgrounds: Fecal occult blood testing (FOBT) is commonly used in colorectal cancer screening programs. Many studies have compared different FOBT methods, but the correlation between traditional red cell microscopy and FOBT remains unclear. Objectives: 1) To evaluate the rate of positive FOBT in patients with different disease groups; 2) To compare the sensitivity and specificity of red blood cells detection in fresh stool by microscopy technique and FOBT. Materials and methods: This was a cross-sectional study involving 120 patients from Hue University of Medicine and Pharmacy Hospital who requested a stool test from 4/2021 to 4/2022. Fresh stool samples were examined for the presence of red blood cells using traditional microscopy and FOBT technique. Results: The overall positivity rate of FOBT was 20%, and in the group of gastrointestinal diseases (n = 24), clinical anemia (n = 21), hepatobiliary diseases (n = 26) and other diseases (n = 49), it was 37.5%, 23.8%, 11.5% and 14.3%, respectively. In comparison with the FOBT technique, microscopic RBC detection had a sensitivity of 33.3% and a specificity of 100%. Conclusions: A high rate of fecal occult blood tests was observed in patients with gastrointestinal disorders. Microscopic erythrocyte detection has low sensitivity and many disadvantages compared to the rapid test. This rapid test should be widely used in clinical practice to aid in the diagnosis of gastrointestinal bleeding Key words: fecal occult blood, microscopic detection, gastrointestinal bleeding.

Výsledky z evaluace screeningu kolorektálního karcinomu v České republice

Introduction: Colorectal cancer screening, which was introduced in the Czech Republic in 2000, plays an important role in reducing the population burden. It is necessary to continuously evaluate the organised population-based program and introduce necessary adjustments to ensure its high effectiveness, which in the long term leads to a reduction in the incidence and mortality of the disease. The aim of this article is to summarise and discuss the key results of the evaluation of the National Colorectal Cancer Screening Program based on available national data. Material and methods: The evaluation used the registries of the National Health Information System, the Registry of Preventive Colonoscopies, and data on population demographics managed by the Czech Statistical Office. The analysis was carried out on available data up to 2021. Basic indicators were calculated in accordance with international recommendations, which were adapted for the Czech environment. Results: A number of performance indicators for colorectal screening demonstrate the negative impact of the COVID-19 pandemic in 2020 and 2021. Coverage of the target population by screening has stabilised at around 30% before the pandemic. Considering a three-year interval, the full coverage of the target population by screening reaches around 50%. Participation rates for follow-up colonoscopy after a positive faecal occult blood test (FOBT) screening ranged between 60 and 70% over time. FOBT screening positivity increased in the recent years up to 10%, which is reflected in the increase in the average waiting time for follow-up FOBT+ colonoscopy. Despite the identified limitations of the screening program, there has been a clear long-term decline in colorectal cancer incidence and mortality. Conclusion: The comprehensive screening information system enables the evaluation of colorectal screening. The evaluated indicators show that despite the positive impact of the screening program on the population burden, it still has its opportunities for improvement, and therefore it is essential to continue its monitoring in order to improve the quality of the whole program. Keywords colonoscopy, colorectal neoplasms, mass screening, occult blood, program evaluation, performance indicators, registries

Colonoscopy indications and findings in older adults

Aims: The share of older population is increasing globally. Colonoscopy is a frequently used diagnostic/therapeutic procedure, no study to our knowledge comprehensively examines the indications and findings of colonoscopy in geriatric population. We aimed to reveal these in older adults.
 Methods: Colonoscopy procedures performed in older adults (≥65 years), which covered a 5-year period (2017-2022), were analyzed retrospectively. Indications and findings of colonoscopies were assessed. The relationship between the indications and the associated findings was also evaluated on an indication basis.
 Results: In the study, 2370 colonoscopy procedures were examined. 27.8% were performed in very old (≥75 years) patients. Colonoscopy was completed in 84.3%. Colon cleansing was not optimal in approximately one-fourth. The frequency of completion of colonoscopies and optimal cleaning were similar in the very old. Iron deficiency anemia (IDA) or fecal occult blood test (FOBT) positivity and screening colonoscopy were the common indications. Regarding indications, IDA-FOBT positivity and bleeding were more frequent, screening colonoscopy, IBD and polyp control were less frequent in the very old group. Colonoscopy was reported as normal in 42.4% of the patients, while polyps (28.3%) and diverticula (17.5%) were the common findings. Among findings tumor, diverticula and solitary rectal ulcer were higher in the very old. IDA -FOBT positivity, bleeding, and colonoscopy performed due to findings of other imaging modalities were related to diagnosis of a tumor.
 Conclusion: In this study, we presented the indications and results of colonoscopy in a large number of older patients. The main indications for colonoscopy can be listed as IDA-FOBT positivity, screening colonoscopy and control of previous polyp-tumor. Near one of two colonoscopies were found to be normal, polyps and diverticula were the major pathologies in the rest. It should be emphasized that IDA -FOBT positivity, bleeding, and findings of other imaging modalities were related to tumor in colonoscopy.

World's first report of sigmoidectomy for sigmoid cancer using the Saroa surgical system with tactile feedback.

Increasing evidence based on the safety and benefits of robot-assisted surgery indicates the disadvantage of the lack of tactile feedback. A lack of tactile feedback increases the risk of intraoperative complications, prolongs operative times, and delays the learning curve. A 40-year-old female patient presented to our hospital with a positive fecal occult blood test. A colonoscopy revealed type 2 advanced cancer of the sigmoid colon, and histological examination showed a well-differentiated adenocarcinoma. Furthermore, abdominal contrast-enhanced computed tomography revealed a tumor in the sigmoid colon and several swollen lymph nodes in the colonic mesentery without distant metastases. The patient was diagnosed with cStage IIIb (cT3N1bM0) sigmoid cancer and underwent sigmoidectomy using the Saroa Surgical System, which was developed by RIVERFIELD, a venture company at the Tokyo Medical and Dental University, and the Tokyo Institute of Technology. Based on adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 176min, with a console time of 116min and 0ml blood loss. The patient was discharged 6days postoperatively without complications. The pathological diagnosis was adenocarcinoma, tub1, tub2, pT2N1bM0, and pStage IIIa. Herein, we report the world's first surgery for sigmoid cancer using the Saroa Surgical System with tactile feedback in which a safe and appropriate oncological surgery was performed.

Health utility assessments in individuals undergoing diagnostic and surveillance colonoscopy: improved discrimination with a cancer-specific scale

PurposeTo compare the sensitivity and discriminant validity of generic and cancer-specific measures for assessing health-related quality of life (HRQoL) for individuals undergoing diagnostic or surveillance colonoscopy for colorectal cancer.MethodsHRQoL was assessed using EQ-5D-5L (generic), and EORTC QLQ-C30 (cancer-specific) scales, 14 days after (baseline) and one-year following colonoscopy (follow-up). Utility scores were calculated by mapping EORTC-QLQ-C30 onto QLU-C10D. Differences between participants with different indications for colonoscopy (positive faecal occult blood test (FOBT), surveillance, or symptoms) and colonoscopy findings (no polyps, polyps, or cancer) were tested using Wilcoxon-Mann–Whitney and Kruskal–Wallis H tests. Sensitivity was assessed by calculating the ceiling effects (proportion reporting the best possible level).Results246 adults completed the survey, including those undergoing colonoscopy for symptoms (n = 87), positive FOBT (n = 92) or surveillance (n = 67). Those with symptoms had the lowest HRQoL at both baseline and follow-up, with differences observed within the HRQoL domains/areas of role function, appetite loss and bowel function on the QLU-C10D. No differences were found in HRQoL when stratified by findings at colonoscopy with both measures or when comparing baseline and follow-up responses. Participants reporting full health with EQ-5D-5L (21% at baseline and 16% at follow-up) still had problems on the QLU-C10D, with fatigue and sleep at baseline and with role function and fatigue at follow-up.ConclusionPatients undergoing colonoscopy for symptoms had lower HRQoL compared to surveillance or positive FOBT. The cancer-specific QLU-C10D was more sensitive and had greater discriminant ability between patients undergoing colonoscopy for different indications.

Endoscopic findings and predictors of gastrointestinal lesions in children with iron deficiency anemia

Iron deficiency anemia (IDA) can be caused by occult gastrointestinal (GI) blood loss; however, the endoscopic findings in children with anemia are unclear. The study aimed to determine the frequency and factors related to lesions in children with IDA undergoing endoscopy. We retrospectively analyzed the clinical and endoscopic findings of children with a laboratory-based diagnosis of IDA. Of 58 patients, 36 (62.1%) had upper GI tract lesions, with erosive gastritis being the most common lesion. Further, 26 patients underwent concomitant colonoscopy, and 12 (46.2%) had lower GI tract lesions. Overall, 44 (75.9%) patients had lesions in either the upper or lower GI tract. Helicobacter pylori infection was detected in 13 patients (22.4%). Patients with lesions found by endoscopy had significantly lower hemoglobin level (8.9 vs. 10.0 g/dL, p = 0.047) and mean corpuscular volume (75.5 vs. 80.9 fL, p = 0.038). The proportion of patients with previous treatment for IDA was also higher in those with lesions on endoscopy. In multivariate analysis, age of ≥10 years (odds ratio [OR], 6.00; 95% confidence Interval [CI], 0.56–10.75) and positive fecal occult blood test (FOBT) findings (OR, 2.25; 95% CI, 0.14–4.52) were factors related to GI lesions. The presence of GI symptoms was not associated with GI lesions. A high proportion of GI lesions were found by endoscopy in children with IDA in this study. Endoscopy should be considered in children with IDA even without GI symptoms, especially in older children, and those with positive FOBT results.

The use of artificial intelligence to identify subjects with a positive FOBT predicted to be non-compliant with both colonoscopy and harbor cancer.

Subjects with a positive Fecal Occult Blood Test (FOBT) that are non-compliant with colonoscopy are at increased risk for colorectal cancer (CRC). Yet, in clinical practice, many remain non-compliant. To evaluate whether machine learning models (ML) can identify subjects with a positive FOBT predicted to be both non-compliant with colonoscopy within six months and harbor CRC (defined as the "target population"). We trained and validated ML models based on extensive administrative and laboratory data about subjects with a positive FOBT between 2011 and 2013 within Clalit Health that were followed for cancer diagnosis up to 2018. Out of 25,219 included subjects, 9,979(39.6%) were non-compliant with colonoscopy, and 202(0.8%) were both non-compliant and harbored cancer. Using ML, we reduced the number of subjects needed to engage from 25,219 to either 971 (3.85%) to identify 25.8%(52/202) of the target population, reducing the number needed to treat (NNT) from 124.8 to 19.4 or to 4,010(15,8%) to identify 55.0%(52/202) of the target population, NNT=39.7. Machine learning technology may help healthcare organizations to identify subjects with a positive FOBT predicted to be both non-compliant with colonoscopy and harbor cancer from the first day of a positive FOBT with improved efficiency.

Positive Fecal Occult Blood Test and Colonoscopy With Histopathology Findings in Saudi Adults.

Background/aims Colorectal cancer cases are on the rise in developing countries, necessitating dependable detection tests. Moreover,medical procedures have become increasingly burdensome for both patients and healthcare professionals. This study aims to delve deeper into the fecal occult blood test (FOBT) as a potential solution. Settings and design The research took place atthe Gastroenterology Specialized Clinic (Human Clinic) in Riyadh, Saudi Arabia. The study gathered results fromcolonoscopy/sigmoidoscopy, histopathology, and FOBTscreening. Essential variables linked tocolorectal cancer, including gastrointestinal symptoms, chronic diseases, hemoglobin (Hgb), body mass index (BMI), and medication usage, were documented to evaluate their potential predictive significance for positive outcomes. Methods and materials In line with the study aims, inclusion criteria covered Saudi adults aged 18 and above, experiencing lower GI symptoms, with colonoscopy or sigmoidoscopy, FOBT, and histopathological results. The resultant sample size was 72 patients. Non-Saudi individuals, symptoms-free patients, and those below 18 years were excluded. This retrospective analysis spanned from September 2021 to September 2022. For statistical analysis, after the data rationality was checked, parametric or non-parametric tests were used. P ≤ 0.05 was set as the significant level. Results Among the 72 patients, ranging in age from 18 to 80(mean 42.94),males (57) outnumbered females (15). The average BMI was 27.56, withone-third of patients classified as overweight or obese. A majority of47 (65.2%) exhibited normal Hgb levelswhile only five (7%) had abnormal levels. Results from colonoscopy or sigmoidoscopy and FOBT displayed statistical similarity between positive and negative outcomes. Additionally, the notable prevalence of positive results compared to negative ones underscores the resemblance between FOBT andcolonoscopy/sigmoidoscopy findings. Conclusion Chronic illness, constitutional symptoms, BMI, and Hgb did not display a significant predictive value, However, the group with GI symptoms exhibited a strong prediction for favorable colonoscopy/sigmoidoscopy and histology outcomes. Additional research is necessary to validate these observed patterns.

Determining efficacy of dynamic multimedia bowel preparation instructions versus standard instructions on adenoma detection and patient reported measures (DIGICLEAN trial): a study protocol for a multicentre, colonoscopist-blinded, randomised controlled trial

IntroductionColonoscopy plays important roles in bowel cancer screening and treatment. Poor bowel preparation occurs in 20–25% of colonoscopies. This negatively impacts adenoma and sessile serrated lesion detection rates, procedural time,...

Combined SEPT9 and BMP3 methylation in plasma for colorectal cancer early detection and screening in a Brazilian population.

Colorectal cancer (CRC) screening can help to reduce its incidence and mortality. Noninvasive strategies, such as plasma analysis of epigenetic alterations, can constitute important biomarkers of CRC detection. This study aimed to evaluate the plasma methylation status of SEPT9 and BMP3 promoters as biomarkers for detection of CRC and its precursor lesions in a Brazilian population. Plasma samples from 262 participants of the CRC screening program of Barretos Cancer Hospital who had a positive fecal occult blood test and underwent colonoscopy and cancer patients were analyzed. Participants were grouped according to the worst lesion detected in the colonoscopy. Cell-free circulating DNA (cfDNA) was bisulfite treated followed by the analysis of SEPT9 and BMP3 methylation status using a droplet digital PCR system (ddPCR). The best methylation cutoff value for group discrimination was calculated by receiver operating characteristic (ROC) curve analysis. Among the 262 participants, 38 were diagnosed with CRC, 46 with advanced adenomas 119 with nonadvanced adenomas, three with sessile serrated lesions, and 13 with hyperplastic polyps. In 43 participants, no lesion was detected in the colonoscopy and were used as controls. The CRC group showed the highest cfDNA concentration (10.4 ng/mL). For the SEPT9 gene, a cutoff of 2.5% (AUC = 0.681) that discriminates between CRC and the control group resulted in CRC sensitivity and specificity of 50% and 90%, respectively. Concerning the BMP3 gene, a cutoff of 2.3% (AUC = 0.576) showed 40% and 90% of sensitivity and specificity for CRC detection, respectively. Combining SEPT9, BMP3 status, and age over 60 years resulted in a better performance for detecting CRC (AUC = 0.845) than the individual gene models, yielding 80% and 81% of sensitivity and specificity, respectively. The present study suggests that a combination of SEPT9 and BMP3 plasma methylation, along with age over 60 years, showed the highest performance in detecting CRC in a Brazilian population. These noninvasive biomarkers can potentially serve as useful tools for CRC screening programs.

Upper GI endoscopy in subjects with positive fecal occult blood test undergoing colonoscopy: systematic review and meta-analysis.

The role of gastroscopy to investigate the upper GI (UGI) tract in subjects with a positive fecal occult blood test (FOBT+) result is controversial. We conducted a systematic review and meta-analysis, which aimed to determine the prevalence of UGI lesions in FOBT+ subjects. Databases were searched until March 31, 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions (CSLs; lesions potentially explaining occult blood loss), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. We included 21 studies with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was .8% (95% CI, .4-1.6) and UGI CSLs was 30.4% (95% CI, 20.7-42.2), and that of colonic cancers and CSLs was 3.3% (95% CI, 1.8-6.0) and 31.9% (95% CI, 23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/without colonic pathology (ORs of 1.2 [95% CI, .9-1.6; P= .137] and 1.6 [95% CI, .5-5.5; P= .460]). Anemia in FOBT+ subjects was associated with UGI cancers (OR, 6.3; 95% CI, 1.3-31.5; P= .025) and UGI CSLs (OR, 4.3; 95% CI, 2.2-8.4; P= .0001). GI symptoms were not associated with UGI CSLs (OR, 1.3; 95% CI, .6-2.8; P= .511). There is an appreciable prevalence of UGI cancers and other CSLs in FOBT+ subjects. Anemia but not symptoms or colonic pathology are linked to UGI lesions. Although the data suggest that same-day gastroscopy in FOBT+ subjects undergoing colonoscopy yields approximately 25% more malignancies as colonoscopy alone, prospective data are required to determine the cost-efficacy of dual endoscopy as a standard of care for all FOBT+ subjects.