{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T23:28:04Z","timestamp":1786663684786,"version":"build-2736575974"},"reference-count":58,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening, colonoscopy after a positive FIT often identifies no CRC or advanced neoplasia, leaving management poorly standardized. We mapped evidence on definitions, extracolonic evaluation, colonoscopy quality, residual CRC risk, and screening re-entry after a positive FIT and nonexplanatory colonoscopy.<\/jats:p>\n                  <jats:p>This registered scoping review followed PRISMA-ScR guidance. PubMed\/MEDLINE, Scopus, and Web of Science were searched until April 2026, along with reference-list screening and targeted searching of official screening program\/policy documents. Sources were charted by one reviewer; included sources, uncertain eligibility decisions, and key findings underwent second-reviewer verification.<\/jats:p>\n                  <jats:p>We included 10 studies on definitions, 11 empirical studies plus three contextual evidence syntheses on evaluation beyond the colon, 11 core empirical studies on colonoscopy quality\/residual CRC risk, and nine empirical studies on management and screening re-entry, supplemented by policy mapping. Definitions varied substantially, supporting \u201cnonexplanatory colonoscopy\u201d as a pragmatic umbrella term. Routine upper gastrointestinal or small-bowel evaluation was not supported in otherwise asymptomatic individuals. Reassurance was quality dependent; residual CRC risk was low in the short term, but not zero. Screening re-entry pathways varied and were not evidence based.<\/jats:p>\n                  <jats:p>Management should first be to establish whether the index colonoscopy is reliable enough to justify reassurance. After a trusted negative examination, the evidence does not support routine upper gastrointestinal or small-bowel evaluation, or routine early repeat colonoscopy in otherwise asymptomatic individuals. Residual CRC risk remains low but not zero, and optimal screening re-entry remains uncertain.<\/jats:p>","DOI":"10.1055\/a-2917-8528","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:56:04Z","timestamp":1786661764000},"source":"Crossref","is-referenced-by-count":0,"title":["Management after a positive fecal immunochemical test and a nonexplanatory colonoscopy: a scoping review and practical decision framework"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8618-2447","authenticated-orcid":false,"given":"Lorenzo","family":"Fuccio","sequence":"additional","affiliation":[{"name":"University of Bologna, Italy","place":["Bologna"],"department":["Medical and Surgical Sciences"]},{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Italy","place":["Bologna"],"department":["Gastroenterology Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3705-841X","authenticated-orcid":false,"given":"Franco","family":"Radaelli","sequence":"additional","affiliation":[{"name":"Valduce Hospital, Lombardia, Italy","place":["Como"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for colorectal cancer: US Preventive Services Task Force Recommendation Statement","volume":"325","author":"KW Davidson","year":"2021","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1136\/gutjnl-2020-320761","article-title":"Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme","volume":"70","author":"SM Peng","year":"2021","journal-title":"Gut"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1053\/j.gastro.2025.10.018","article-title":"Characteristics of colonoscopy- and fecal immunochemical test-based screen-detected premalignant neoplastic lesions: results from the COLONPREV study","volume":"170","author":"A Castells","year":"2026","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1055\/a-2136-6564","article-title":"Interval post-colonoscopy colorectal cancer following a negative colonoscopy in a fecal immunochemical test-based screening program","volume":"55","author":"HJ van de Schootbrugge-Vandermeer","year":"2023","journal-title":"Endoscopy"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2023.102309","article-title":"What do \u201cfalse-positive\u201d stool tests really mean? 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