ArticleUnited European gastroenterology journal2023
Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study.
Article in United European gastroenterology journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 7 citations in OpenAlex.
- Gut dysbiosis in oncology: a risk factor for immunoresistance.Cell research · 2026Review
- The Role of Calprotectin in the Diagnosis and Treatment of Inflammatory Bowel Disease.International journal of molecular sciences · 2025Review
- Development and validation of a faecal immunochemical test-based model in the work-up of patients with iron deficiency anaemia.Frontiers in medicine · 2024Article
- Fecal occult blood and calprotectin testing to prioritize primary care patients for colonoscopy referral: The advantage study.United European gastroenterology journal · 2023Article
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Authors and funding
20 authors at 11 institutions in 2 countries.
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Abstract
backgroundColonoscopy is the gold standard for colorectal cancer (CRC) diagnosis and screening, but endoscopy services are usually overburdened. This study aims to investigate the usefulness of fecal hemoglobin (fHb) and calprotectin (FC) for the identification of patients with high probability of CRC who need urgent referral.
methodsIn a multicenter prospective study, we enrolled symptomatic patients referred from primary care for colonoscopy. Prior to bowel preparation, fHb and FC quantitative tests were performed. The diagnostic performance was estimated for each biomarker/combination. We built a multivariable predictive model based on logistic regression, translated to a nomogram and a risk calculator to assist clinicians in the decision-making process.
resultsThe study included 1224 patients, of whom 69 (5.6%) had CRC. At the fHb cut-offs of >0 and 10 μg/g, the negative predictive values for CRC were 98.8% (95% confidence interval 97.8%-99.3%) and 98.6% (95%CI 97.7%-99.1%), and the sensitivities were 85.5% (95%CI 75.0%-92.8%) and 79.7% (95%CI 68.3%-88.4%), respectively. When we added the cut-off of 150 μg/g of FC to both fHb thresholds, the sensitivity of fecal tests improved. In the multivariate logistic regression model, the concentration of fHb was an independent predictor for CRC; age and gender were also independently associated with CRC.
conclusionsfHb and FC are useful as part of a triage tool to identify those symptomatic patients with high probability of CRC. This can be easily applied by physicians to prioritize high-risk patients for urgent colonoscopy.
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