Compliance and yield of follow-up colonoscopy after a positive FIT in real-life practice: a university hospital experience.
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BACKGROUND: The fecal immunochemical test (FIT) is a diagnostic modality for colorectal cancer (CRC) screening, with the US Multisociety Task Force setting an 80% adherence benchmark for follow-up colonoscopy (FUC). Guidelines recommend that FITs be performed only in the context of CRC screening. METHODS: Our study is a retrospective review of all patients with positive FIT records from 2018 to 2023. Patient characteristics, FIT ordering practices, and clinical settings were collected. The compliance rates with FUC, colonoscopy diagnostic yield, and adenoma detection were analyzed, and adherent and nonadherent patients were compared via univariate and logistic regression analyses. RESULTS: A total of 1424 patients had positive FIT results, with ages ranging between 18 and 92 years. Among the 1424 patients, 245 (17.2%) were < 45 years (group 1), 829 (52.9%) were 45-75 years (group 2), and 350 (24.6%) were > 75 years (group 3). In group 2, 241 (16.9%) tests were conducted for CRC screening. Seven hundred and three (49.3%) positive FIT tests, including tests for abdominal pain and anemia, were carried out for diagnostic purposes. Only 618 (43.3%) patients with positive FIT results underwent FUC, of whom 277 (44.8%) had adenomas and 28 (4.5%) were diagnosed with CRC. Bivariate analysis revealed that age, fewer comorbidities, prior colonoscopy, family history of CRC, diagnostic FIT, and outpatient setting increased FUC adherence. Multivariate analysis revealed that age and outpatient setting were predictive factors. CONCLUSION: Although FITs are used for CRC screening, our study found a discrepancy between guidelines and real-world practice. Compliance with FUC after a positive FIT is below the optimal range, with adherence decreasing with age.