{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:08:00Z","timestamp":1790690880633,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Fecal immunochemical test\u2010based colorectal cancer screening is effective; however, colonoscopy demand exceeds endoscopy capacity. Delays in colonoscopy after a positive test reduce screening effectiveness. We developed and validated a decision\u2010tree model to stratify colorectal cancer risk among individuals with a positive test to prioritize colonoscopy for those at highest risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective study including participants with a positive fecal immunochemical test referred for colonoscopy within a Spanish regional population\u2010based screening program (2021\u20132024). Individuals were randomly assigned to derivation (65%) and validation (35%) cohorts using a stratified random split. Fecal hemoglobin concentration, clinical and laboratory data were collected to develop the decision\u2010tree model. The primary outcomes were colorectal cancer and advanced\u2010stage colorectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1773 participants were included. Colorectal cancer was detected in 97 participants (5.5%), including 25 cases (1.5%) with advanced\u2010stage disease. The model stratified participants into low\u2010, intermediate\u2010, high\u2010, and very high\u2010risk groups. A progressive increase in the prevalence of colorectal cancer and advanced\u2010stage disease was observed across risk groups in both cohorts (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The very high\u2010risk group (fecal hemoglobin &gt;\u2009100\u2009\u03bcg\/g and\u2009&gt;\u200965\u2009years) included 6.7% of participants, with colorectal cancer and advanced\u2010stage prevalence of 21.8% and 7.6%, respectively. Prioritizing colonoscopy for this group yielded a number needed to scope of 4.6 for colorectal cancer and 13.2 for advanced\u2010stage disease, both significantly lower than the current one\u2010size\u2010fits\u2010all strategy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A decision\u2010tree model was developed to stratify the risk of colorectal cancer and optimize endoscopic resources in screening programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/den.70224","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:15:38Z","timestamp":1784182538000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Stratification to Optimize Colorectal Cancer Screening: Development and Validation of a Decision\u2010Tree Model for Colonoscopy Prioritization"],"prefix":"10.1111","volume":"38","author":[{"given":"Mar\u00eda","family":"Capilla\u2010Lozano","sequence":"first","affiliation":[{"name":"Digestive Disease Department Clinic University Hospital of Valencia, INCLIVA Health Research Institute  Valencia Spain"},{"name":"Digestive Disease Department Hospital Universitario de La Plana  Vila\u2010real Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Qui\u00f1ones\u2010Torrelo","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department Clinic University Hospital of Valencia, INCLIVA Health Research Institute  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Sebasti\u00e1n\u2010Peris","sequence":"additional","affiliation":[{"name":"Department of Applied Statistics Operations Research and Quality, Universitat Polit\u00e8cnica de Val\u00e8ncia  Valencia 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