Background & aims: Current adenoma detection rate (ADR) benchmarks for colonoscopy in individuals positive for a fecal immunochemical test (FIT), are ≥45% in males and ≥35% in females. These are based on weak, low-quality evidence. We performed a meta-analysis to ascertain the pooled ADR in FIT-positive colonoscopy. Methods: Major databases like PubMed, EMBASE and Web-of-Science were searched in Oct-2021 for studies reporting on ADR of colonoscopy in FIT-positive population. Meta-analysis was performed by standard methodology using the random-effects model. Heterogeneity was assessed by I2% and 95% prediction-interval statistics. Results: 34 high-quality studies that included more than 6-million asymptomatic average risk individuals were analyzed. 2,655,345 individuals completed a screening FIT test. The pooled FIT screening rate was 69.8% (95% CI [62.8-76.1]), the pooled FIT positivity rate was 5.4%[4.3-6.9], and the colonoscopy completion rate was 85%[82.8-86.9]. The pooled ADR was 47.8%[44.1-51.6], pooled aADR was 25.3%[22-29], and the pooled CRCDR was 5.1%[4.4-5.9]. The pooled ADR in males was 58.3%[52.8-63.6] and in females was 41.9%[36.4-47.6]. The pooled ADR with qualitative FIT assessment was 67.7%[50.7-81], with 1-stool sample FIT was 52.8%[48.8-56.8] and at a cut-off threshold of 100ngHb/ml was 52.1%[47-57.1]. Based on time-period cumulative analysis, the ADR improved over time from 30.5%[24.6-37.2] to 47.8%[44.1-51.6]. Conclusion: This meta-analysis supports the current ADR benchmarks for colonoscopy in FIT-positive individuals. Excellent pooled ADR parameters were demonstrated with qualitative assessment of one stool sample at a test cut-off value of 100ng Hb/ml, and ADR per endoscopist improved over time.
Pooled Rates of Adenoma Detection by Colonoscopy in Asymptomatic Average Risk Individuals with Positive Fecal Immunochemical Test: A Systematic Review and Meta-Analysis
Facciorusso, Antonio;
2022-01-01
Abstract
Background & aims: Current adenoma detection rate (ADR) benchmarks for colonoscopy in individuals positive for a fecal immunochemical test (FIT), are ≥45% in males and ≥35% in females. These are based on weak, low-quality evidence. We performed a meta-analysis to ascertain the pooled ADR in FIT-positive colonoscopy. Methods: Major databases like PubMed, EMBASE and Web-of-Science were searched in Oct-2021 for studies reporting on ADR of colonoscopy in FIT-positive population. Meta-analysis was performed by standard methodology using the random-effects model. Heterogeneity was assessed by I2% and 95% prediction-interval statistics. Results: 34 high-quality studies that included more than 6-million asymptomatic average risk individuals were analyzed. 2,655,345 individuals completed a screening FIT test. The pooled FIT screening rate was 69.8% (95% CI [62.8-76.1]), the pooled FIT positivity rate was 5.4%[4.3-6.9], and the colonoscopy completion rate was 85%[82.8-86.9]. The pooled ADR was 47.8%[44.1-51.6], pooled aADR was 25.3%[22-29], and the pooled CRCDR was 5.1%[4.4-5.9]. The pooled ADR in males was 58.3%[52.8-63.6] and in females was 41.9%[36.4-47.6]. The pooled ADR with qualitative FIT assessment was 67.7%[50.7-81], with 1-stool sample FIT was 52.8%[48.8-56.8] and at a cut-off threshold of 100ngHb/ml was 52.1%[47-57.1]. Based on time-period cumulative analysis, the ADR improved over time from 30.5%[24.6-37.2] to 47.8%[44.1-51.6]. Conclusion: This meta-analysis supports the current ADR benchmarks for colonoscopy in FIT-positive individuals. Excellent pooled ADR parameters were demonstrated with qualitative assessment of one stool sample at a test cut-off value of 100ng Hb/ml, and ADR per endoscopist improved over time.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
