610 Self-Expanding Metal Stents for Treatment of Benign Anastomotic Biliary Strictures in Liver Transplant Patients, Room for Improvement - Final 5 Year Results of a Multi-Center Study (original) (raw)

2018, Gastrointestinal Endoscopy

Background & aim: Fecal immunochemical test (FIT) and sigmoidoscopy have been used for colorectal cancer (CRC) screening worldwide. However, the limitations are poorer test sensitivity for advanced neoplasia (AN) and isolated detection in distal colon, respectively. Through this prospective multicenter trial, we compared the detection rate of AN between FIT plus sigmoidoscopy (SIG) based colonoscopy (FITS group) and colonoscopy (COLO group). Methods: From October 2012 to March 2017, asymptomatic average subjects in the age of 45 to 75 who did not undergo screening colonoscopy or who have a history of colonoscopy at least 5 years before or a history of SIG 3 years before were enrolled at 13 tertiary hospitals. Eligible subjects were randomized to FITS group or COLO group. In FITS group, FIT was performed before endoscopy date and then, sigmoidoscopy was followed by colonoscopy on the same date. If FIT was over the threshold or any adenomas were found by SIG, the test was considered as positive. We calculated FIT and FITS based program sensitivity (ST), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) under the assumption that colonoscopy should be performed only in subjects with positive FIT or positive SIG. We defined an AN as an adenoma more than 10 mm in size or having villous components or high grade dysplasia or cancer. Results: Among 3,658 subjects enrolled, data from 3,651 were completely filled up and were analyzed (FITS: 1,821 vs. COLO: 1,830). In FITS group, positive rate of FIT was 5.0% (86/1,731) with threshold of 100 ng/Ml and positive rate of SIG was 15.1% (273/1,821). In FITS group, FIT based colonoscopy program could find only 13 of 137 ANs (ST 9.5%, SP 95.4%, PPV 15.1%, NPV 92.5%, respectively). Also, SIG based colonoscopy program could find only 45.9% (67/146) of ANs. Even though we applied combined FIT and SIG based colonoscopy strategy, we could only increase ANs detection rate up to 47.9% (70/146). Finally, among all subjects, 70 ANs (3.8%, 70/1,821) were supposed to be found in FITS based colonoscopy program, whereas 143 ANs were found (7.9%, 143/1830) in COLO group, which was significantly higher than those found by FITS strategy (p<0.001). Conclusion: Compared to direct colonoscopy, FIT plus SIG based colonoscopy program could only find about half number of ANs, suggesting colonoscopy priority under the circumstances of high adherence rate to CRC screening program.