Simple Fecal Blood Test Could Reduce Unnecessary Endoscopies

A new diagnostic strategy for patients with suspected serious colorectal disease (SCD) could reduce the need for endoscopy by nearly a third, according to a new study.

Researchers at University Medical Center Utrecht (UMCU; The Netherlands), Gelderse Vallei Hospital (Ede, The Netherlands) and other hospitals across the Netherlands conducted a cross-sectional diagnostic study of 810 patients with suspected SCD referred by 266 primary general practitioner (GP) practices for endoscopy; all of the patients underwent a fecal immunochemical test (FIT), which uses an antibody that recognizes human hemoglobin, and so can be used to detect the presence of blood in a patients stool sample.

The results showed that out of the 810 patients referred for an endoscopy, 669 had no SCD. Once the results of the FIT test were taken into account, the researchers found that approximately 30% of these patients could have been prevented from having an endoscopy at all, as they may have been correctly diagnosed as not having SCD during their clinical visit. The researchers also examined the benefit of adding a fecal calprotectin (FCal) test to the diagnostic strategy; while this test did improve the diagnosis of SCD, it was not to the same extent as FIT. The study was published on September 26, 2016, in BMC Medicine.

“The amount of patients that are unnecessarily referred for an endoscopy strains health care budgets and exposes patients to a small but realistic risk from endoscopy associated complications,” said lead author Sjoerd Elias, MD, of UMCU, and colleagues. “Our study found that using a test called FIT, which detects the presence of hemoglobin in the patient's feces, alongside the usual diagnostic work up done by GPs could rule out nearly a third of patients from requiring an endoscopy to check for SCD.”

SCD, which includes colorectal cancer, is difficult to diagnose as the signs and symptoms are not always clear. Any suspicion of SCD requires a GP referral to a hospital for an endoscopy, but numerous studies have shown that between 60-80% of referred patients end up not having SCD.

Related Links:
University Medical Center Utrecht
Gelderse Vallei Hospital