Monti Gabriel, Clark Ellen, Lieberman David
Department of Medicine, Oregon Health & Science University, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, USA.
Dig Dis Sci. 2025 Mar;70(3):991-995. doi: 10.1007/s10620-025-08848-9. Epub 2025 Jan 22.
Colorectal cancer screening with fecal immunochemical testing (FIT) is a process that depends on diagnostic colonoscopy for those with a positive test and completion of colonoscopy after positive FIT is an essential element of program effectiveness.
We examined how the COVID-19 pandemic influenced completion of diagnostic colonoscopy after positive FIT in our integrated healthcare system.
This was a retrospective study of all positive FIT over a 5-year period. FITs were characterized as being done in pre-pandemic, early pandemic, or late pandemic time periods. The primary outcome was proportion of timely diagnostic colonoscopy completed within 6 months of positive FIT.
Among 2157 patients with positive FIT, 50% received diagnostic colonoscopy within 6 months, 20% received colonoscopy after 6 months, and 30% received no colonoscopy. 56% of patients had timely colonoscopy during the pre-pandemic period as compared to 39% in the early pandemic and 49% in the late pandemic (p value < 0.01 for all comparisons). Those who had their colonoscopy done via community care referral were less likely to do so within 6 months. Among patients with no colonoscopy, the most common reasons included patient declined (48%), clinicians deferred due to comorbid conditions (26%), or the patient died (21%).
Before and during the pandemic, we found low rates of completion of colonoscopy after a positive FIT, which highlights an important barrier to program effectiveness. Many FIT were inappropriate given the high proportion of patients who either died or were recommended not to complete a colonoscopy.
粪便免疫化学检测（FIT）用于结直肠癌筛查，该过程对于检测结果呈阳性者依赖于诊断性结肠镜检查，而FIT检测结果呈阳性后完成结肠镜检查是项目有效性的关键要素。
我们研究了2019冠状病毒病（COVID-19）大流行如何影响我们综合医疗系统中FIT检测结果呈阳性后的诊断性结肠镜检查的完成情况。
这是一项对5年内所有FIT检测结果呈阳性者的回顾性研究。FIT检测被分为在大流行前、大流行早期或大流行后期进行。主要结局是在FIT检测结果呈阳性后的6个月内完成及时诊断性结肠镜检查的比例。
在2157例FIT检测结果呈阳性的患者中，50%在6个月内接受了诊断性结肠镜检查，20%在6个月后接受了结肠镜检查，30%未接受结肠镜检查。在大流行前时期，56%的患者及时接受了结肠镜检查，而在大流行早期为39%，在大流行后期为49%（所有比较的p值均<0.01）。通过社区护理转诊进行结肠镜检查的患者在6个月内进行检查的可能性较小。在未接受结肠镜检查的患者中，最常见的原因包括患者拒绝（48%）、临床医生因合并症而推迟（26%）或患者死亡（21%）。
在大流行之前和期间，我们发现FIT检测结果呈阳性后结肠镜检查的完成率较低，这凸显了项目有效性的一个重要障碍。鉴于有很大比例的患者要么死亡要么被建议不完成结肠镜检查，许多FIT检测并不合适。
