Is a fecal occult blood test a useful tool for judging whether to perform capsule endoscopy in low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy?
BACKGROUND
Aspirin use is reportedly not to be associated with fecal immunochemical occult blood test (FIT) false-positive results for the detection of colorectal cancer. The need for additional small bowel exploration in FIT-positive, low-dose aspirin users with a negative colonoscopy is controversial. The aim of this study was to assess the ability of FIT to judge whether capsule endoscopy (CE) should be performed in low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy findings by comparing FIT results with CE findings.


METHODS
A total of 264 consecutive low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy who were scheduled to undergo CE at five hospitals in Japan were enrolled. Patients had been offered FIT prior to the CE. The association between the FIT results and the CE findings was then assessed.


RESULTS
One hundred and fifty-seven patients were included in the final analysis. Eighty-four patients (53.5 %) had positive FIT results. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of positive FIT results for small bowel ulcers were 0.56, 0.47, 0.30, and 0.73, respectively. Furthermore, the NPV of positive FIT results for severe small bowel injury (Lewis score ≥790) was markedly high (0.90). When the analysis was performed only in low-dose aspirin users with anemia, the sensitivity of the positive FIT results was notably improved (0.72).


CONCLUSIONS
Small bowel evaluation using CE is not recommended for FIT-negative, low-dose aspirin users. However, small bowel evaluation using CE should be considered in both FIT-positive and anemic low-dose aspirin users.
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. endo1978@yokohama-cu.ac.jp.
Hiroki
H
Endo
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Takayuki
T
Kato
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Eiji
E
Sakai
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan.
Leo
L
Taniguchi
Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan.
Jun
J
Arimoto
Department of Gastroenterology, Odawara Municipal Hospital, Odawara, Japan.
Harunobu
H
Kawamura
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Takuma
T
Higurashi
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Hidenori
H
Ohkubo
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Takashi
T
Nonaka
Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Masataka
M
Taguri
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Masahiko
M
Inamori
Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Takeharu
T
Yamanaka
Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan.
Takashi
T
Sakaguchi
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan.
Yasuo
Y
Hata
Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan.
Hajime
H
Nagase
Division of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Atsushi
A
Nakajima
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000473:pathology; D001241:Aspirin / Q000008:administration & dosage*; D053704:Capsule Endoscopy / Q000379:methods*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007120:Immunochemistry / Q000379:methods; D007564:Japan; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D001241:Aspirin
Capsule endoscopy; Fecal immunochemical occult blood test; Low-dose aspirin; Small bowel