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Updated: Aug 7, 2026
Murine Endoscopy for In Vivo Multimodal Imaging of Carcinogenesis and Assessment of Intestinal Wound Healing and Inflammation
Published on: August 26, 2014
A prospective study of same day bi-directional endoscopy in the evaluation of patients with occult gastrointestinal
1Department of Internal Medicine, Diakonhjemmet Hospital, PO Box 23, Vinderen, NO-0319 Oslo, Norway. njaalstray@hotmail.com
Insights
Bi-directional endoscopy found potential bleeding sources in 50% of patients with occult gastrointestinal bleeding (OGIB). Colonoscopy yielded more positive results, especially in older adults, and detected more cancers than oesophagogastroduodenoscopy (OGD).
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
- Gastrointestinal Bleeding
Background:
- Occult gastrointestinal bleeding (OGIB) investigations often yield conflicting results regarding diagnostic yield.
- Bi-directional endoscopy (oesophagogastroduodenoscopy [OGD] and colonoscopy) is used to identify potential bleeding sources (PBS) in OGIB patients.
- Predictive factors for a positive diagnostic yield in OGIB remain unclear.
Purpose of the Study:
- To evaluate the diagnostic yield of bi-directional endoscopy in patients presenting with OGIB.
- To identify clinical factors predictive of a positive diagnostic yield in OGIB patients.
- To compare the diagnostic yield and cancer detection rates of colonoscopy versus OGD in OGIB.
Main Methods:
- Prospective study of patients with OGIB referred to a gastroenterology unit.
- Colonoscopy was performed, immediately followed by OGD.
- Predetermined criteria were used to diagnose PBS, and clinical factors were assessed for predictive value.
Main Results:
- 50% of 219 patients (mean age 65) had at least one PBS.
- Colonoscopy identified 87 PBS in 73 patients (33%), primarily adenomas.
- OGD identified 49 PBS in 48 patients (22%), mainly gastric ulcers. Cancer was detected in 3 patients with concurrent PBS at both procedures.
- Positive yield was lower with isolated positive fecal occult blood test (FOBT) or iron-deficiency anemia (IDA) compared to combined positive FOBT and IDA. PBS detection increased with age.
Conclusions:
- Bi-directional endoscopy identified PBS in 50% of OGIB patients.
- Colonoscopy demonstrated a higher diagnostic yield and cancer detection rate than OGD.
- Colonoscopy is recommended for older patients with OGIB, regardless of OGD findings. Gastrointestinal symptoms and NSAID/ASA use were not predictive of PBS detection.
Objective:
Previous studies show conflicting results in the diagnostic yield of oesophagogastroduodenoscopy (OGD) and colonoscopy (bi-directional) in identifying potential bleeding sources (PBS) in patients investigated for occult gastrointestinal bleeding (OGIB). The aims of this study were to evaluate the diagnostic yield of bi-directional endoscopy in patients presenting with OGIB and to assess the factors predictive of a positive yield.
Material And Methods:
Patients with OGIB referred to the gastroenterology unit were prospectively included in the study. Colonoscopy was immediately followed by OGD. Predetermined criteria for the diagnosis of a PBS were used. Potential clinical factors predictive of positive yield were assessed.
Results:
Of the 219 patients (mean age 65 years, 34% M), 110 (50%) had at least one PBS. Colonoscopy revealed 87 PBS in 73 patients (33%), the most common being adenoma. OGD detected 49 PBS in 48 patients (22%), gastric ulcer being the most common. Of the patients with PBS at OGD, 23% also had a PBS at colonoscopy, including 3 patients with colonic cancers. Patients presenting with either a positive faecal occult blood test (FOBT) or iron-deficiency anaemia (IDA) only had a significantly lower yield for PBS than patients with combined positive FOBT and IDA. The percentages of patients with a PBS increased substantially with age.
Conclusions:
A PBS was found in only 50% of the patients. Colonoscopy had a slightly higher diagnostic yield, and as expected, resulted in a significantly higher cancer detection rate than OGD. In older patients, colonoscopy should be done irrespective of the findings at OGD. Gastrointestinal-specific symptoms and the use of ASA/NSAIDs were not predictive in finding or localizing PBS.
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