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结直肠癌筛查最常用的方法。然而，其有效性经常因检测结果呈阳性后未能进行后续结肠镜检查而受到损害。

评估在粪便测试（愈创木脂或免疫化学）呈阳性结果后提高成人后续结肠镜检查率的干预措施。

来自 Cochrane 对照试验中央注册库、PubMed 和 Embase 的英语研究，从数据库建立到 2017 年 6 月。

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。

两名评审员独立提取数据并对研究质量进行排名； 2 对每个研究类型类别的证据的总体强度进行了评级。

23 项研究符合分析条件，其中包括 7 项随机研究和 16 项非随机研究。其中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（提醒或绩效数据）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表现数据。系统级干预的证据很少。 17 项研究报告了与对照组人群相比完成结肠镜检查的测试阳性患者的比例，绝对差异为 -7.4 个百分点（95% CI，-19 至 4.3 个百分点）至 25 个百分点（CI，14 至 35 个百分点）点）。

超过一半的研究存在高或极高偏倚风险；异质的研究设计和特征排除了荟萃分析。

患者导航并向提供者提供提醒或表现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措施的证据很少且不充分。

国家癌症研究所。 （普洛斯彼罗：CRD42016048286）