Evaluation of colonoscopy and histopathology results in patients undergoing colonoscopy for occult blood positivity in stool

Background and Aims: Fecal occult blood test is frequently used as a first-line screening method for colorectal cancer. In addition to fecal occult blood test, other screening methods include fecal immunohistochemical test, sigmoidoscopy, and colonoscopy. This study aims to evaluate the colonoscopy and histopathology results of patients who underwent colonoscopy due to a positive fecal occult blood test. Materials and Methods: This study included patients who underwent colonoscopy due to a positive fecal occult blood test at Antalya Training and Research Hospital between January 2020 and December 2024. Patients with inadequate bowel preparation, a known history of colorectal cancer, or inflammatory bowel disease were excluded. The age, gender, colonoscopy findings, and histopathological results of the included patients were recorded. Results: A total of 508 patients were included in the study, of whom 260 (51.2%) were male and 248 (48.8%) were female, with a median age of 61 years (range: 20 - 95). The median hemoglobin level was 13.5 g/dL (range: 5 - 16.3). Colonoscopy findings were normal in 196 (38.6%) patients. Other findings included polyps in 107 (21.1%), inflammatory bowel disease in 70 (13.8%), perianal disease in 59 (11.6%), colorectal cancer in 31 (6.1%), diverticula in 26 (5.1%), ulcers in 15 (3%), and angiodysplasia in 4 (0.8%) patients. A total of 223 (43.8%) patients with suspected colorectal cancer or polyps underwent biopsy. Histopathological examination revealed adenomatous polyps in 77 (34.5%) patients, inflammatory bowel disease in 59 (26.5%), adenocarcinoma in 31 (13.9%), and hyperplastic polyps in 26 (11.7%) patients, while 30 (13.5%) patients had no pathological findings. Conclusion: Nearly half of the patients who underwent colonoscopy due to a positive fecal occult blood test were found to have colonic pathology. Fecal occult blood test is a simple, cost-effective, and practical test not only for detecting colorectal cancer and precancerous lesions but also for identifying other colonic pathologies such as inflammatory bowel disease, diverticula, and perianal diseases.