Advantages of Routine Upper-Gastrointestinal Endoscopy
in Positive Fecal Occult Blood Tests with
Negative Colonoscopy Results
Chonlada Krutsri MD1, Chairat Supsamutchai MD1, Pitichote Hiranyatheb MD1, Pongsasit Singhatas MD1,
Tharin Thampongsa MD1, Jakrapan Jirasiritham MD1
Affiliation :
1 Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Fecal occult blood test [FOBT] is a popular use for colorectal cancer screening. When positive results are found,
colonoscopy is necessary to (cid:976)ind pathologic lesion. However, in many patients, nothing can be identi(cid:976)ied 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 bene(cid:976)its of routine use of esophago-
gastroduodenoscopy [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 (cid:976)inding 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.
Keywords : Esophagogastroscope, Negative colonoscope, Fecal occult blood positive
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