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Patients with a positive fecal occult blood test (FOBT) should undergo colonoscopy, and those who refuse are at high risk for developing symptomatic colorectal cancer, which may be advanced at presentation. Rates of colonoscopy refusal in programmatic FOBT screening range from 10% to over 30%.
In a study conducted in France, over 750 patients with positive FOBT who refused colonoscopy were randomized to receive an invitation letter for video capsule endoscopy (VCE) or computed tomography colonography (CTC). The procedure completion rate was similar between groups (5% for VCE and 7% for CTC). An additional 30 patients underwent colonoscopy after the invitation, without undergoing either VCE or CTC. Potentially neoplastic lesions were discover…