Systematic Review and Meta-analysis of Adenoma Detection Rates in FIT-positive Patients

Systematic Review and Meta-analysis of Adenoma Detection Rates in FIT-positive Patients

Douglas K. Rex, MD, MASGE, reviewing Mohan BP, et al. Gastrointest Endosc 2022 Apr 9.

The U.S. Multi-Society Task Force on Colorectal Cancer recommends minimally acceptable adenoma detection rates (ADRs) in primary screening colonoscopy of 30% in men and 20% in women, but in patients with positive fecal immunochemical test (FIT) results, the respective recommended ADRs are 45% and 35%. This systematic review and meta-analysis identified 34 high-quality studies that included more than 2.6 million individuals screened by FIT and 163,839 who were FIT-positive.

The pooled FIT-positivity rate in the studies was 5.4%, and the pooled colonoscopy completion rate was 85%. In FIT-positive persons, the pooled ADR was 47.8%, the advanced adenoma ADR was 25.3%, and cancer was identified in 5.1%. In addition, the pooled ADRs were 58.3% in males and 41.9% in females. Over the period included in the studies’ cumulative analysis, the pooled ADR improved from 30.5% to 47.8%.

Douglas K. Rex, MD, FASGE


These data confirm that ADRs should be at least 15% higher in FIT-positive patients than in primary-screening colonoscopy patients and that advanced adenomas and cancers are very prevalent in FIT-positive patients. For U.S. endoscopists, the most important lesson is that FIT-positive patients are one group of patients that should not be included in the ADR calculations for primary screening.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Mohan BP, Khan SR, Daugherty E, et al. Pooled rates of adenoma detection by colonoscopy in asymptomatic average risk individuals with positive fecal immunochemical test: a systematic review and meta-analysis. Gastrointest Endosc 2022 Apr 9. (Epub ahead of print) (

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