Is gastroscopy for fecal immunochemical test positive patients worthwhile?
BACKGROUND
The use of fecal immunochemical test (FIT) in the screening for colorectal cancer is long established. However, more than 50 % of patients with positive FITs have a negative colonoscopy. The role of a subsequent oesophago-gastro-duodenoscopy (OGD) is debatable. The aim of this study is to evaluate the yield of OGD in patients with positive FITs.


METHODS
A retrospective review of patients who underwent colonoscopy for a positive FIT between Jan. 2008 and Dec. 2012 was identified from a prospectively collected endoscopy database at the National University Hospital, Singapore. Patients who underwent concurrent or subsequent OGDs for positive FIT formed the study group. We considered any new cancer or significant upper gastrointestinal pathology such as peptic ulcer disease or gastritis requiring treatment as a positive examination.


RESULTS
A total of 202 patients underwent both a colonoscopy and an OGD for a positive FIT and formed the study group. One hundred and six (52.5 %) of them had a positive examination with gastritis and duodenitis representing the most common UGI pathology in 89 (44.1 %) patients. Twenty-nine (14.4 %) patients tested positive for helicobacter pylori infection and another 16 (7.9 %) patients had peptic ulcer disease. There were no UGI cancers detected. One patient had an esophageal leiomyoma that was treated conservatively.


CONCLUSIONS
Routine gastroscopy for FIT positivity has a high diagnostic yield for benign upper gastrointestinal pathology. Well-designed prospective studies to further evaluate the cost-effectiveness of routine gastroscopy in the work up of FIT positivity are warranted to make better clinical practice guidelines.
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
Jing Yu
JY
Ng
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
Dedrick Kok Hong
DK
Chan
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. ker_kan_tan@nuhs.edu.sg.|Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. ker_kan_tan@nuhs.edu.sg.
Ker Kan
KK
Tan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003710:Demography; D005243:Feces / Q000737:chemistry*; D005260:Female; D005773:Gastroscopy; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
Fecal immunochemical test; Gastroscopy; Oesophago-gastro-duodenoscopy
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