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Flexible sigmoidoscopy following a positive faecal occult blood test within a bowel screening programme may reduce the detection of neoplasia
Author(s) -
Mansouri D.,
McMillan D. C.,
Roxburgh C. S. D.,
Moug S. J.,
Crighton E. M.,
Horgan P. G.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12377
Subject(s) - sigmoidoscopy , medicine , colonoscopy , fecal occult blood , colorectal cancer , gastroenterology , dysplasia , endoscopy , occult , cancer , general surgery , pathology , alternative medicine
Aim Colorectal cancer screening using the faecal occult blood test ( FOB t) detects a disproportionate number of left‐sided tumours. This study aims to examine the theoretical impact on neoplasia detection rates of a sigmoidoscopy‐first protocol in FOB t‐positive patients undergoing colonoscopy. Method From retrieved endoscopy/pathology reports, pathology up to and including the splenic flexure was assumed detectable by sigmoidoscopy. High‐risk polyps prompting subsequent colonoscopy were classed as three or more polyps, one polyp of ≥ 1 cm, villous or tubulovillous components or the presence of high‐grade dysplasia. Results Between A pril 2009 and A pril 2011, 4631 patients underwent colonoscopy as a result of a positive FOB t in G reater G lasgow and C lyde. Cancer was detected in 398 (9%) and adenomas were detected in 1985 (47%) of which 1323 (67%) were deemed significant according to B ritish S ociety of G astroenterology guidelines. Applying the flexible sigmoidoscopy‐first model, cancer would have been detected in 329 (8%) patients and adenomas in 1640 (39%), of which 1140 (70%) would have been significant. In total, 1546 (37%) patients would have required subsequent colonoscopy, following which 21 patients would have a new diagnosis of cancer. The positive predictive values ( PPV s) for neoplasia (47 vs 57%, P < 0.001), significant neoplasia (35 vs 41%, P < 0.001) and cancer (8 vs 9%, P = 0.007) were all lower in the sigmoidoscopy‐first model. Conclusion A significant reduction in the detection of both adenomas and cancers would be seen if the sigmoidoscopy‐first protocol were to be used following a positive FOB t. Furthermore, a significant proportion of patients would be subjected to two procedures, with considerable implications for both the patient and cost.