Abstract

Background A prompt colonoscopy (COL) evaluation has been considered mandatory for patients with colorectal cancer (CRC) related symptoms. However, patients with low-risk CRC symptoms raise the demand of COL, with no clear benefit about their urgent evaluation. The use of fecal immunochemical test (FIT) has been advocated as a method to select symptomatic patient for urgent COL, but its potential CRC protective effects during follow-up have not been extensively described. We present the results of a pilot study exploring the use of a qualitative FIT to prioritize the selection of patients with low-risk CRC symptoms for COL in a public hospital from Latin America, and the effects of COVID-19 pandemic on delay follow-up on these patients. Methods We included patients between 40-75 years old who were referred for COL evaluation to a tertiary public hospital from Santiago, Chile between January 1, 2018 to December 31,2019. We excluded patients with high-risk symptoms related to CRC such as recent (<1 month) hematochezia/rectal bleeding, anemia and palpable abdominal and/or rectal mass. Patients were evaluated by a trained nursing staff to assess CRC related symptoms, comorbidities, and health-related habits. If high-risk CRC symptoms were identified during nurse evaluation, patients were referred for urgent COL. For the remaining patients, a qualitative FIT was indicated: if positive, an urgent COL was indicated; if negative, annual FIT surveillance was recommended. To assess the effects of delayed surveillance due COVID-19 pandemic, electronic medical records (EMR) for all FIT-negative patients were reviewed searching for CRC-diagnosis. Results A total of 847 patients were included. Demographic data and symptoms at presentation are summarized in Table 1. An 82.3% (697) of FIT adherence was observed. A 31.6% (220/697) of patient had a positive FIT, with a total of 24 (10.9%) CRC diagnosed in this group. For negative FIT patients, a median delay of 2.5 years due COVID pandemic was observed. According to EMR evaluation, no patients develop any CRC during this period when FIT was negative. Conclusions In our study, FIT help to discriminate patients that need urgent COL evaluation among those with low- risk CRC-related symptoms. Additionally, a negative FIT result may be associated with a protective effect to safely delay COL evaluation in this group of patients. Further prospective studies with COL evaluation of negative FIT patients are needed to validate this strategy.