A summary of ‘Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test by Pin-Vieito et al,. January 2020’
This study by Pin-Vieito et al., assesses whether symptomatic patients that had no colorectal cancer (CRC) after a positive FIT result have an increased risk of developing other gastrointestinal (GI) cancer resulting in death. It is theorised that some conditions could result in blood passing from the gastrointestinal tract into the colon unmetabolised, therefore the question was posed: could a positive FIT result (>10 µg Hb /g faeces) be related to other GI cancers?
In total 2709 symptomatic patients were included in the study. All participants completed a FIT and a colonoscopy, with the Colonoscopist blind to the FIT results. FIT was taken from a single stool sample from one bowel movement with no dietary restrictions. Using a cut off of 10 µg Hb/g Faeces, the testing population were organised into positive FIT and negative FIT groups. 1979 participants (73.1%) were FIT negative and 730 (26.9%) were FIT positive. All various cancers that presented with blood in the gastrointestinal tract were noted. GI Cancer of varying degrees were detected in 57 (2.1%) of the FIT negative population.
This study highlighted a higher than expected risk of GI cancers in patients presenting with lower gastrointestinal symptoms and no colorectal cancer detected in colonoscopy. Age and anaemia were associated with GI cancer detection but statistically the probability of detecting a GI cancer is unrelated to FIT result, with both FIT negative and positive cohorts yielding similar results.
With regards to patient follow up, this study demonstrated that the risk of post-colonoscopy colorectal cancer diagnosis was clearly associated with the FIT result. The risk is low, however, following high-quality colonoscopy CRC detection was increased in symptomatic subjects with positive FIT when compared to patients with a negative test. If abdominal symptoms persist following colonoscopy, safety netting is encouraged.
To read the full study click here
- Pin-Vieito N, Iglesias MJ, Remedios D, et al. Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test. World J Gastroenterol. 2020;26(1):70–85