TOPLINE:

Faecal immunochemical testing (FIT)-based triage identified symptomatic colonoscopy referrals as those at the highest risk for colorectal cancer, inflammatory bowel disease (IBD), and large polyps. FIT values ≥ 10 μg Hb/g identified patients at high risk — including those aged 40-49 years — whereas FIT values < 10 μg Hb/g indicated a very low risk.

METHODOLOGY:

• Researchers analysed 447,109 symptomatic colonoscopies performed at 412 sites in the United Kingdom (June 2023 to August 2025), using a national database that mandates recording of FIT results, to evaluate the diagnostic performance of colonoscopy after FIT implementation and whether age, sex, and symptoms influence disease detection.
• They categorised FIT results into two analysis groups: FIT values < 10 μg Hb/g (including all numeric values < 10 μg Hb/g and any "FIT-negative" results) and FIT values ≥ 10 μg Hb/g (including all numeric values ≥ 10 μg Hb/g and any "FIT-positive" results).
• Colonoscopies performed to investigate patients with gastrointestinal symptoms, anaemia, and iron‑deficiency anaemia were referred to as symptomatic colonoscopies.

TAKEAWAY:

• Overall, the yield of colorectal cancer was 1.9%. Colonoscopies after FIT values ≥ 10 μg Hb/g were more likely to detect colorectal cancer and were significantly more likely to detect IBD and large polyps (P < .001 for both).
• The detection of colorectal cancer and large polyps increased with age, and in each age group (16-39, 40-49, and 50-59 years), detection rates were higher for patients with FIT values ≥ 10 μg Hb/g than for those with FIT values < 10 μg Hb/g (P < .001 for all).
• Iron-deficiency anaemia was an independent predictor of colorectal cancer compared with rectal bleeding (adjusted odds ratio [aOR], 2.2); anaemia also signalled the risk but to a lesser extent (aOR, 1.3; P < .001 for both).
• A model reserving colonoscopy for patients with a risk of ≥ 1% for colorectal cancer would have detected more than 94% of cancers while cutting colonoscopy demand by over 40%.

IN PRACTICE:

"To fully realise the benefits of this approach, integration of FIT into all symptomatic referrals should now be a national priority, alongside efforts to minimise colonoscopy in FIT-negative patients. This approach would improve CRC [colorectal cancer] detection, support equitable access to colonoscopy and ensure the greatest benefits for patients and the health service," the authors of the study wrote.

SOURCE:

This study was led by David Beaton, Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, England. It was published online on January 28, 2026, in Alimentary Pharmacology and Therapeutics.

LIMITATIONS:

Because the analysis relied on endoscopy reports, some indications and findings may have been misclassified — particularly cancers contained within polyps that were not recognised as malignant at endoscopy. Also, although more than 99% of UK sites submitted data to the National Endoscopy Database (NED), a small number had not yet transitioned to the second iteration of the NED during the study period, which could have affected data completeness.

DISCLOSURES:

This study did not report any specific funding. One author reported receiving unrestricted project grants from 3-D Matrix and Medtronic and funding from the National Institute for Health and Care Research Newcastle Patient Safety Research Collaboration.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.