title: Fecal occult blood testing for the prediction of small-bowel pathology detected by capsule endoscopy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Fecal occult blood testing (FOBT) has been suggested as a potential screening tool for small-bowel capsule endoscopy (CE). We conducted a meta-analysis of studies correlating FOBT and CE findings to examine the predictive value of positive FOBT for CE findings.
  
  
  METHODS
  PubMed and Embase search. Sensitivity, specificity and diagnostic odds ratios (DORs) were calculated.
  
  
  RESULTS
  Six studies were identified. Four used fecal immunochemical testing (FIT), one used FIT and guaiac FOBT, one used hemoglobin/haptoglobin complex testing (Hb/Hpt). Five of the 6 studies were suitable for statistical analysis. For all positive FOBT, sensitivity for small-bowel findings was 0.60 (95%CI 0.50-0.69), specificity was 0.72 (95%CI 0.52-0.86), and DOR was 3.96 (95%CI 1.50-10.4). For the 4 studies using only FIT, sensitivity was 0.48 (95%CI 0.36-0.61), specificity was 0.60 (95%CI 0.42-0.76), and DOR was 1.41 (95%CI 0.72-2.75).
  
  
  CONCLUSIONS
  Although a number of modalities have been suggested for screening small-bowel CE referrals, none of them, including FOBT, offer a comprehensive solution. Further work is required to refine screening methods for small-bowel CE referrals.
authors.affiliation: Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Diana Yung, Sarah Douglas, Anastasios Koulaouzidis).
authors.forename: Diana E
authors.initials: DE
authors.lastname: Yung
authors.affiliation: College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom (Sanju Vijayan).
authors.forename: Sanju
authors.initials: S
authors.lastname: Vijayan
authors.affiliation: Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel (Tomer Avni).
authors.forename: Tomer
authors.initials: T
authors.lastname: Avni
authors.affiliation: Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Diana Yung, Sarah Douglas, Anastasios Koulaouzidis).
authors.forename: Sarah
authors.initials: S
authors.lastname: Douglas
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel (Uri Kopylov).
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.affiliation: Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Diana Yung, Sarah Douglas, Anastasios Koulaouzidis).
authors.forename: Anastasios
authors.initials: A
authors.lastname: Koulaouzidis
keywords: Capsule endoscopy; fecal immunochemical test; fecal occult blood test; meta-analysis; small bowel; systematic review