title: Bidirectional endoscopy in patients with fecal occult blood.
abstract: BACKGROUND
  Current screening protocols for colorectal cancer depend primarily on fecal occult blood testing (FOBT). However, positive test results do not always indicate the presence of a colonic neoplasm.
  
  
  METHODS
  We reviewed the results of 100 consecutive bidirectional (upper and lower) endoscopic procedures performed to evaluate positive FOBT results. Patients were excluded if they presented with gross bleeding, a history of bowel lesions, or previous intestinal operations. There were 31 women and 69 men whose mean age was 51 years.
  
  
  RESULTS
  Major abnormalities were found on esophagogastroduodenoscopy (n = 24), colonoscopy (n = 13), or both studies (n = 2). Active bleeding was manifested in two patients, (Barrett's ulcer, duodenal arteriovenous malformation). Two other patients had malignancy: One had a cecal adenocarcinoma and the other a gastric adenocarcinoma. Various benign lesions also were identified in the stomach including esophagitis (n = 8), ulcers/erosions (n = 8) varices (n = 5), and arteriovenous malformations (n = 2). Colonic pathology included polyps (n = 8), arteriovenous malformations (n = 3), and rectal varices (n = 1). Diverticulosis and hemorrhoidal disease were present in 29 and 16 patients, respectively, but were not considered to be likely sources of a positive FOBT.
  
  
  CONCLUSIONS
  Positive FOBT results may indicate the presence of either upper or lower intestinal pathology, and bidirectional endoscopy is an efficient and accurate technique for the comprehensive evaluation of occult bleeding.
authors.affiliation: Clinica "SOMA,", 521 Avenue, Oriental x La Playa, Calle 51 No. 45-93, Medellin, Columbia.
authors.forename: J P
authors.initials: JP
authors.lastname: Velez
authors.forename: W H
authors.initials: WH
authors.lastname: Schwesinger
authors.forename: J
authors.initials: J
authors.lastname: Stauffer
authors.forename: H V
authors.initials: HV
authors.lastname: Gaskill
authors.forename: G B
authors.initials: GB
authors.lastname: Kazantsev
authors.forename: K R
authors.initials: KR
authors.lastname: Sirinek
authors.forename: W E
authors.initials: WE
authors.lastname: Strodel
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis; D001165:Arteriovenous Malformations / Q000175:diagnosis; D002430:Cecal Neoplasms / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis; D004240:Diverticulum / Q000175:diagnosis; D004384:Duodenoscopy / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies