The compliance rate for the second diagnostic evaluation after a positive fecal occult blood test: A systematic review and meta-analysis. Issue 3 (April 2019)

• Record Type: Journal Article
• Authors: Gingold-Belfer, Rachel; Leibovitzh, Haim; Boltin, Doron; Issa, Nidal; Tsadok Perets, Tsachi; Dickman, Ram; Niv, Yaron
• Is Part Of: United European Gastroenterology journal. Volume 7:Issue 3(2019)
• Page Start: 424
• Page End: 448
• Publication Date: 2019-04
• Subjects: Compliance rate -- CRC prevention -- diagnostic yield -- fecal occult blood test -- follow-up colonoscopy; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640619828185
• Languages: English
• ISSNs: 2050-6406

Abstract

Introduction: Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for colorectal cancer (CRC) prevention. We aimed to obtain a precise estimation of this problem and also assess the diagnostic yield of CRC and adenomas by colonoscopy in these patients. Methods: Literature searches were conducted for "compliance" OR "adherence" AND "fecal occult blood test" OR "fecal immunohistochemical test" AND "colonoscopy." Comprehensive meta-analysis software was used. Results: The search resulted in 42 studies (512, 496 patients with positive FOBT), published through December 31, 2017. A funnel plot demonstrates a moderate publication bias. Compliance with any second procedure, colonoscopy, or combination of double-contrast barium enema with or without sigmoidoscopy in patients with a positive FOBT was 0.725 with 95% confidence interval (CI) 0.649–0.790 ( p = 0.000), 0.804 with 95% CI 0.740–0.856 ( p = 0.000) and 0.197 with 95% CI 0.096–0.361 ( p = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050–0.068 ( p = 0.000), 0.242 with 95% CI 0.188–0.306 ( p = 0.000) and 0.147 with 95% CI 0.116–0.184 ( p < 0.001), respectively. Discussion: Compliance with diagnostic evaluation after a positive FOBT is still suboptimal. Therefore, measures to increase compliance need to be taken given the increased risk of CRC in these patients.