Delays in Diagnostic Colonoscopy After Positive FIT in an Integrated Healthcare System

Area of Science:

• Gastroenterology
• Public Health
• Oncology

Background:

• Colorectal cancer screening relies on fecal immunochemical testing (FIT) followed by diagnostic colonoscopy for positive results.
• Completion of colonoscopy after a positive FIT is crucial for the effectiveness of screening programs.

Purpose of the Study:

• To assess the impact of the COVID-19 pandemic on diagnostic colonoscopy completion rates after positive FIT.
• To analyze trends in colonoscopy completion before, during the early, and late pandemic periods.

Main Methods:

• Retrospective study of patients with positive FIT over a 5-year period.
• Categorization of FIT tests into pre-pandemic, early pandemic, and late pandemic phases.
• Primary outcome: proportion of timely diagnostic colonoscopies completed within 6 months of a positive FIT.

Main Results:

• Only 50% of patients completed diagnostic colonoscopy within 6 months of a positive FIT.
• Timely colonoscopy rates decreased from 56% pre-pandemic to 39% early pandemic and 49% late pandemic.
• Common reasons for no colonoscopy included patient decline, clinician deferral due to comorbidities, or patient death.

Conclusions:

• Low rates of colonoscopy completion after positive FIT were observed both before and during the pandemic, indicating a significant barrier to screening program effectiveness.
• A substantial proportion of positive FIT results may have been inappropriate, given high rates of patient death or medical contraindications for colonoscopy.