The Compliance Rate for the Second Diagnostic Evaluation After a Positive Fecal Occult Blood Test: A Systematic Review and Meta-analysis

Overview

Journal United European Gastroenterol J

Publisher Wiley

Specialty Gastroenterology

Date 2019 Apr 26

PMID 31019712

Citations 16

Authors

Rachel Gingold-Belfer

Haim Leibovitzh

Doron Boltin

Nidal Issa

Tsachi Tsadok Perets

Ram Dickman

Yaron Niv

Affiliations

Soon will be listed here.

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 ( = 0.000), 0.804 with 95% CI 0.740-0.856 ( = 0.000) and 0.197 with 95% CI 0.096-0.361 ( = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050-0.068 ( = 0.000), 0.242 with 95% CI 0.188-0.306 ( = 0.000) and 0.147 with 95% CI 0.116-0.184 ( < 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.

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