Upper Gastrointestinal Endoscopy in Patients With a Positive Faecal Occult Blood Test Result Undergoing Colonoscopy

BACKGROUND AND AIMS

The role of gastroscopy to investigate the upper gastrointestinal (UGI) tract in subjects with positive faecal occult blood test (FOBT+) is controversial. We conducted a systematic review and meta-analysis, which aimed to determine the prevalence of UGI lesions in FOBT+ subjects.

METHODS

Databases were searched until April 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions ((CSL), lesions potentially explaining occult blood loss)), Odds Ratio (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

We included 21 studies, with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was 0.8% (95%CI0.4-1.6) and UGI CSL was 30.4% (95%CI20.7-42.2), while that of colonic cancers and CSL was 3.3% (95%CI1.8-6.0) and 31.9% (95%CI23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/ without colonic pathology, (OR=1.2, 95%CI0.9-1.6, p=0.137, and OR=1.6, 95%CI0.5-5.5, p=0.460, respectively). Anaemia in FOBT+ subjects was associated with UGI cancers (OR=6.3, 95%CI1.3-31.5, p=0.025) and UGI CSL (OR=4.3, 95%CI2.2-8.4, p=0.0001). Gastrointestinal symptoms were not associated with UGI CSL (OR=1.3, 95%CI 0.6-2.8, p=0.511).

CONCLUSIONS

In FOBT+ subjects there is an appreciable prevalence of UGI cancers and other CSL. Anaemia but not symptoms or colonic pathology are linked to UGI lesions. While the data suggest that same day gastroscopy in FOBT+ subjects undergoing colonoscopy yields approximately 25% more malignancies as colonoscopy alone, prospective data are required to determine the cost-efficacy of dual-endoscopy as a standard of care for all FOBT+ subjects.