CT-Detected Incidental Colorectal Wall Thickening: Biomarker-Augmented Triage and Accelerated Colonoscopy in a Prospective Controlled Study

Maha Mohammed Mahmoud

doi:10.54133/ajms.v11i2.3228

Authors

Maha Mohammed Mahmoud Department of Radiology, College of Medicine, University of Tikrit, Tikrit, Iraq https://orcid.org/0009-0002-6698-0366

DOI:

https://doi.org/10.54133/ajms.v11i2.3228

Keywords:

Biomarker-augmented triage, Computed tomography, Colonoscopy, Fecal immunochemical test, Incidental colorectal wall thickening

Abstract

Background: Colorectal wall thickening identified incidentally on imaging of the abdomen poses a clinical challenge because subsequent management is variable. Incorporation of biological markers may enhance triage allocation without the need for additional imaging. Objective: To evaluate whether biomarker-enhanced triage improves colonoscopy prioritization for patients with incidental colorectal wall thickening findings. Methods: A prospective, controlled pilot trial randomized 50 adult outpatients with CT-detected incidental colorectal wall thickening (1:1) with usual care vs. a biomarker-augmented triage pathway. Intervention includes fecal immunochemical testing, fecal calprotectin, C-reactive protein, complete blood counts, albumin, and symptom profiling to prioritize urgent, expedited, or routine endoscopic referral. Results: Biomarker-guided triage accelerated referral patterns overall, with 92.0% of study-arm patients assigned to urgent or expedited referrals vs. 60.0% in the control group. This pathway was associated with a decrease in the median time to colonoscopy (43 vs. 22 days, p<0.01) and a significant improvement in the proportion of colonoscopies performed within 30 days (68.0% vs. 20.0%; p<0.01). Patients with clinically significant disease had significantly higher fecal hemoglobin (83.84±28.84 vs. 3.43±1.88 µg Hb/g) and fecal calprotectin (467.51±129.86 vs. 86.99±40.72 µg/g). Radiologically, the most prominent association with patients having significant disease was with marked wall thickening (OR=28.42). Conclusions: A stool and blood biomarker profile based on routine radiology reports enables rapid appraisal with clinically relevant capabilities to inform subsequent endoscopy. This triage strategy provides a rapid non-imaging assessment of clinical severity and should be extended to a larger cohort for validation.

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