Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy?
OBJECTIVE
There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy.


METHODS
All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed.


RESULTS
During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001).


CONCLUSIONS
Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia.
Bini
E J
EJ
Division of Gastroenterology, New York University Medical Center, Bellevue Hospital, and New York Veterans Affairs Medical Center, 10010, USA.
Rajapaksa
R C
RC
Valdes
M T
MT
Weinshel
E H
EH
D000368:Aged; D003113:Colonoscopy; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D018579:Patient Selection; D010437:Peptic Ulcer / Q000175:diagnosis; D013274:Stomach Neoplasms / Q000175:diagnosis