Is gastroscopy for fecal immunochemical test positive patients worthwhile?

Area of Science:

• Gastroenterology
• Oncology
• Diagnostic Medicine

Background:

• Fecal immunochemical test (FIT) is a standard colorectal cancer screening tool.
• Over 50% of positive FIT results lead to negative colonoscopies.
• The utility of subsequent oesophago-gastro-duodenoscopy (OGD) after a positive FIT is unclear.

Purpose of the Study:

• To assess the diagnostic yield of OGD in patients with positive FIT results.
• To determine the prevalence of significant upper gastrointestinal pathology in this patient group.

Main Methods:

• Retrospective review of 202 patients undergoing colonoscopy and OGD for positive FIT (Jan 2008-Dec 2012).
• Data sourced from a prospectively collected endoscopy database.
• Positive examination defined as new cancer or significant upper GI pathology requiring treatment.

Main Results:

• 52.5% of patients had positive OGD findings.
• Gastritis and duodenitis were the most common pathologies (44.1%).
• Helicobacter pylori infection (14.4%) and peptic ulcer disease (7.9%) were identified; no upper GI cancers were detected.

Conclusions:

• Routine OGD following a positive FIT demonstrates a high yield for detecting benign upper gastrointestinal conditions.
• Further prospective research is recommended to evaluate the cost-effectiveness of routine OGD in FIT-positive workups.
• Evidence is needed to refine clinical practice guidelines for FIT-positive patients.