Colonoscopies in FIT-positive persons should aim for higher adenoma detection rate than primary colonoscopy

A cohort study of adults undergoing a colonoscopy after a positive fecal immunochemical testing (FIT) result suggest that endoscopists performing colonoscopy in FIT-based screening programs should aim for markedly higher adenoma detection rate compared with programs that use colonoscopy as the primary screening intervention. The study is published in Annals of Internal Medicine.

Screening reduces colorectal cancer (CRC) incidence and mortality by early detection and removal of colorectal cancers and polyps. One of the quality indicators for colonoscopies is the adenoma detection rate, which proportion of colonoscopies in which at least one adenoma is detected. Adenoma detection rate is often associated with inverse post-colonoscopy CRC (PCCRC) risk, and many professional societies recommended endoscopists have an ADR of at least 25 percent.

FIT-based screening programs have also become common worldwide. Participants with a positive FIT result have a high prevalence of adenomas, leading to high ADRs for endoscopists performing colonoscopies in this setting. However, it is unknown whether the association between the ADR and PCCRC is also present in colonoscopies performed after a positive FIT result.

Researchers from Erasmus University Medical Center, Rotterdam, conducted a population-based cohort study of 362 endoscopists who performed 116,360 colonoscopies with a median ADR of 67%. In 426 participants diagnosed with PCCRCs, 49% were classified as interval cancer and 51% were classified as noninterval cancer. The authors found that higher ADR was associated with lower PCCRC incidence, and that colonoscopy in FIT-positive persons demands a markedly higher ADR target than primary colonoscopy.