title: Yield of dual endoscopy for positive fecal occult blood test.
abstract: OBJECTIVE
  Dual endoscopy is frequently performed on the same day in patients whose stools are found to be positive on fecal occult blood testing (FOBT). This is often done to localize the potential sources of GI bleed. The diagnostic yield of same day dual upper endoscopy (EGD) and lower endoscopy (colonoscopy) for the detection of positive FOBT is uncertain. In the era of cost-efficient medical practice, we investigated whether a more evidence-based and structured approach could be used to guide physicians to the workup of patients who present with positive FOBT.
  
  
  METHODS
  We performed a retrospective analysis of 309 patients, and 260 patients from this population met our inclusion criteria. Inclusion criteria included FOBT without acute GI hemorrhage, hematochezia, or melena. Patients were required to have had EGD and colonoscopy within the same day (<24 h).
  
  
  RESULTS
  Of 260 patients, a total of 135 (52%) patients had positive findings on colonoscopy and a total of 42 (16.1%) patients had positive findings on EGD. Sixteen (6.1%) had positive EGD and negative colonoscopy; 109 (42%) had positive colonoscopy and negative EGD; and 26 (10%) had positive findings on both EGD and colonoscopy.
  
  
  CONCLUSIONS
  Colonoscopy should be chosen as the initial procedure of choice in the evaluation of patients who present with positive FOBT. Same day dual endoscopy does not seem to be cost-effective.
authors.affiliation: New York Medical College, Department of Medicine, Saint Vincent's Catholic Medical Center, Staten Island, New York 10310, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.forename: M
authors.initials: M
authors.lastname: Yaqub
authors.forename: Z
authors.initials: Z
authors.lastname: Haider
authors.forename: I
authors.initials: I
authors.lastname: Anees
authors.forename: S
authors.initials: S
authors.lastname: Bhargava
authors.forename: J
authors.initials: J
authors.lastname: Gian
mesh_terms: D003113:Colonoscopy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies