Priority stratification for colonoscopy based on two-sample faecal immunochemical test screening: results from a cross-sectional study at an endoscopy clinic in Japan.

OBJECTIVES: Little has been reported on the yield and characteristics of colorectal neoplasia detected by the two-sample faecal immunochemical test (FIT), particularly the difference between subjects with two-positive results on the two-sample FIT and those with one-positive results. We aimed to assess risk stratification among patients with positive two-sample FIT to prioritise colonoscopy. DESIGN: A retrospective cross-sectional study. SETTING: A single-centre, representative endoscopy clinic in Japan. PARTICIPANTS: Consecutive patients who underwent colonoscopy were enrolled. Indications for colonoscopy included two-positive results on the two-sample FIT (FIT (+/+)), one-positive results on the two-sample FIT (FIT (+/-)), and other reasons (non-FIT group, including presence of symptoms, screening or surveillance). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were detection rates of colorectal cancers, including in situ (all cancers) and invasive cancers, based on the indications for colonoscopy. Secondary outcomes were cancer features, such as location, size, T stage and histological subtype. RESULTS: Of the 8724 patients, 264 underwent colonoscopy following FIT (+/+), 1018 following FIT (+/-) and 7442 for reasons other than positive FIT. Detection rates of all (and invasive) cancers in the FIT (+/+), FIT (+/-) and non-FIT groups were 12.1% (8.3%), 1.9% (0.3%) and 0.4% (0.2%), respectively. The cancer detection rates were much higher in the FIT (+/+) group than in the FIT (+/-) group, which in turn had higher rates than the non-FIT group. Moreover, the FIT (+/+) group showed more advanced T stages on tumour, node, metastasis (TNM) classification (Tis/T1/T2/T3/T4: 10/7/4/10/1) than the FIT (+/-) group (16/1/2/0/0, p<0.001). CONCLUSIONS: Two-positive results for two-sample FIT showed a much higher yield for more advanced colorectal cancers than the one-positive result. High priority for diagnostic colonoscopy should be assigned to patients with two-positive-FIT results.

Endoscopic scleroligation is a superior new technique for preventing recurrence of esophageal varices.

This study compared a new method, endoscopic scleroligation, intravariceal injection sclerotherapy followed by ligation plus extravariceal injection sclerotherapy, with ligation plus extravariceal injection sclerotherapy. Fifty-nine patients with cirrhosis and esophageal varices were treated by endoscopic scleroligation (ESL group, n = 28) or ligation plus extravariceal injection sclerotherapy (EVL + extraEIS group, n = 31). The demographics and clinical characteristics of the two treatment groups were similar, as was the rate of complete eradication with initial treatment. However, the 1- and 3-year cumulative recurrence rates in the ESL group (3.8% and 22.4%) were very significantly lower than those in the EVL + extraEIS group (48.3% and 81.0%) (p < 0.0001). The overall survival rates in the two groups were similar. In conclusion, endoscopic scleroligation is superior to ligation plus extravariceal injection sclerotherapy in preventing variceal recurrence. The efficacy of intravariceal injection sclerotherapy before ligation is believed to arise from the eradication of feeder vessels.