Triage at diagnostic colonoscopy

Validation of Triage
in Selection to Diagnostic Colonoscopy
among subjects with symptoms
attributable to colorectal cancer


The ENDOSCOPI IV – project:

(over a 3-year period from spring 2018)


The TRIAGE-concept:

(1) a person’s age + (2) a FIT+- test (=test for occult blood in feces)  +  (3) a blood-based biomarker test

has shown a much more accurate selection for colonoscopy than screening based on a FIT-test alone.

Now, the concept will be validated for selection to diagnostic colonoscopy.
Over a 2½ year-period, the project will include 5,000 subjects
referred to colonoscopy due to symptoms of CRC.

Presumably, the use of Triage may reduce the overall need for colonoscopy
also in diagnostic colonoscopy among subjects with symptoms attributable to CRC.

The Endoscopy IV- results can be of major national as well as international value:
cf:  Triage in screening for colorectalcancer

  • for health budgets
  • but even more for the individual, who will avoid
    an unpleasant examination with possible risk of side effects.

The project with additional protocols has been approved by
the Ethics Committee of the Capital Region of Denmark (H-17031325) and the Danish Data Protection Agency.


Outlines of the Endoscopy IV study:

Research Schedule and Sites:


Start-up as a pilot project Oct.2018—
to be fully implemented by mdeio Jan 2019-ultimo 2020:

Collection of blood samples, data and records
from 5,000 subject referred to colonoscopy due to symptoms of CRC.
is carried out by the Endoscopy centers at 9 collaborating hospitals:

  • The Capital Region:
    Amager, Hvidovre, Bispebjerg, Herlev and Hillerød Hospitals
  • The Central Region of Denmark:
    Herning, Horsens, Randers, and Viborg Regions Hospitals

Aims are to include approximately 500 subjects diagnosed with CRC, and 750 subjects with adenomas:

  • A combination of the person’s age + the person’s results of a FIT-test and a blood-test
    will be assessed in relation to findings of the colonoscopy.
  • Thus, validating the selection efficacy of using the Triage–concept
    for diagnostic colonoscopy of subjects referred due to symptoms of CRC.


year 2021:

Analyses and statistical calculations
are carried out by collaborating academic and commercial laboratories
—according to signed contracts.

NOTE:  all analyzes performed by collaborators does not burden the project financially:


At present, approx. 40 persons are employed by our two,
parallel running studies—Endo III + IV—distributed at the mentioned hospitals:

  • The study initiator and PI is: Kornerup Professor Hans Jørgen Nielsen, MD, DMSc,
    Department of Surgical Gastroenterology 360, University of Copenhagen
    at Hvidovre Hospital, 2650 Hvidovre
  • A steering committee and an executive board act as advisers of the study.


Budget and financing:

  • The budget for the Endoscopy IV- project (2018–2021 incl.) 
    —excluding analysis costs—is approx. 19 million DKK.
    The project is financed partly by Danish and European private funds;
    partly through collaborating laboratories—both academically and commercially based.
  • All national and international academic and commercial laboratory collaborations
    are based on a keen interest in access to our comprehensive, well-documented test material.
  • All collaborations are conducted according to signed collaboration contracts.                       Cf. Sponsors     


Perspectives of the project-results:

  • possible concepts for reducing the overall number of colonoscopies
    has been on the program at the latest meetings in
    Early Detection Research Network at National Cancer Institute, Bethesda, USA

Primarily because:

CRC-screenings should gradually be offered all citizens between 40 and 85 years of age—
—(where, the current recommendations are: all 50-74 years of age; used in Denmark)

Today, an increasing number of young people—under the age of 50—
are diagnosed with the CRC-disease.

At the same time, the population is getting older and older—and maintain a continued healthy life.


As consequence of the health-economic system in the United States:

  • many—having a screening-test with elevated FIT-results—will develop
    a CRC-disease before deciding on a costly, subsequent colonoscopy.

A blood test after a FIT-screening would emphasize the necessity of possibly urgent colonoscopy.


Read more:

Why Triage        Application of research results

The publication on the basic research results: 
“Serological biomarkers in triage of FIT-positive subjects?”

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ColoRectal Cancer Research

Gastroenheden, Hvidovre Hospital

Kettegård Allé 30

2650 Hvidovre