Advantages of routine upper-gastrointestinal endoscopy in positive fecal occult blood tests with negative colonoscopy results

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: Fecal occult blood test [FOBT] is a popular use for colorectal cancer screening. When positive results are found, colonoscopy is necessary to find pathologic lesion. However, in many patients, nothing can be identified in the colon or rectum. In this situation some surgeons prefer to perform bidirectional endoscopy to search for the source of the bleeding. Currently, there is no standard guideline or recommendation to support this, nor is there evidence against it. Objective: To determine the predictive value of upper gastrointestinal pathology and benefits of routine use of esophagogastroduodenoscopy [EGD] after negative colonoscopy in positive FOBT. Materials and Methods: A retrospective medical records review between January 1, 2015 and December 31, 2016. All patients who had FOBT for screening colorectal cancer and positive results were included in the present study. Patients had undergone colonoscopy and EGD on the same day in the surgery unit and had negative finding in complete colonoscopy. The exclusion criteria were active gastrointestinal bleeding, pre-existing gastrointestinal disease, and previous gastrointestinal tract surgery. Results: From the method, 185 patients with negative colonoscopy were enrolled. The mean age was 62.57 years. There were 145 females (78.38%) and 40 males (21.62%). In 160 patients who had pathological lesion from EGD, we found 117 cases (73.13%) with gastritis and no patients with gastric cancer. In 160 patients, there were 25 cases (15.63%) with dyspepsia. Of the 25 dyspepsia patients, there were 18 cases (69.23%) who had Helicobacter pylori infection. Conclusion: EGD has a higher yield for diagnosing benign lesions, but not for gastric cancer, in FOBT-positive patients. Dual endoscopy may be cost effective in terms of early treatment and the reduced chance of future problems. In some patients, we diagnosed and eradicated H. pylori, therefore reducing the risk of gastric cancer.