Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
United European Gastroenterol J. 2019 Apr;7(3):424-448. doi: 10.1177/2050640619828185. Epub 2019 Feb 6.
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.
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.
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.
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.
只有少数粪便潜血试验（FOBT）阳性的患者接受后续的二次诊断程序，从而最大限度地降低了其在结直肠癌（CRC）预防中的作用。我们旨在准确评估这一问题，并评估这些患者结肠镜检查对 CRC 和腺瘤的诊断效果。
对“依从性”或“顺应性”和“粪便潜血试验”或“粪便免疫化学试验”和“结肠镜检查”进行文献检索。使用综合荟萃分析软件。
搜索结果为 42 项研究（512496 例 FOBT 阳性患者），发表时间截至 2017 年 12 月 31 日。漏斗图显示存在中度发表偏倚。FOBT 阳性患者对任何二次检查（结肠镜检查）或双重对比钡灌肠联合或不联合乙状结肠镜检查的依从性为 0.725（95%CI 0.649-0.790； = 0.000）、0.804（95%CI 0.740-0.856； = 0.000）和 0.197（95%CI 0.096-0.361； = 0.000）。CRC、高级腺瘤和单纯性腺瘤的诊断率分别为 0.058（95%CI 0.050-0.068； = 0.000）、0.242（95%CI 0.188-0.306； = 0.000）和 0.147（95%CI 0.116-0.184； < 0.001）。
FOBT 阳性后诊断评估的依从性仍然不理想。因此，鉴于这些患者 CRC 风险增加，需要采取措施提高依从性。
