Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results.

To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical).

English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017.

Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results.

Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type.

Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points).

More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis.

Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient.

National Cancer Institute. (PROSPERO: CRD42016048286)

粪便免疫化学检测是全球最常用的结直肠癌筛查方法。然而，它的有效性经常因在阳性检测结果后未能获得后续结肠镜检查而受到破坏。

评估干预措施以提高粪便检测（愈创木脂或免疫化学）阳性结果后的成人结肠镜检查率。

从数据库开始到 2017 年 6 月，来自 Cochrane Central Register of Controlled Trials、PubMed 和 Embase 的英语语言研究。

随机和非随机研究报告了对粪便检测结果呈阳性的无症状成人进行结肠镜检查随访的干预措施。

两名审稿人独立提取资料并对研究质量进行排名；2 对每种研究类型的总体证据强度进行了评级。

23 项研究符合分析条件，包括 7 项随机研究和 16 项非随机研究。三人的偏倚风险较低。11 项研究描述了患者层面的干预措施（更改邀请、提供结果或随访预约以及患者导航）、5 项提供者层面的干预措施（提醒或性能数据）和 7 项系统层面的干预措施（自动转诊、结肠镜检查前电话电话、患者登记和质量改进工作）。中等证据支持患者导航器和提供者提醒或性能数据。系统级干预的证据很少。17 项研究报告了完成结肠镜检查的阳性患者与对照组相比的比例，绝对差异为 -7.4 个百分点（95% CI，-19 至 4.

超过一半的研究存在高或非常高的偏倚风险；异质性研究设计和特征排除了荟萃分析。

患者导航器和提供者提醒或性能数据可能有助于提高粪便血液检测结果呈阳性的无症状成人的结肠镜检查率。目前关于有用的系统级干预的证据很少且不充分。

国家癌症研究所。(PROSPERO: CRD42016048286)