Upper GI endoscopy in subjects with positive fecal occult blood test undergoing colonoscopy: systematic review and meta-analysis.

Humans Occult Blood Prospective Studies Colonoscopy Endoscopy, Gastrointestinal Colorectal Neoplasms / diagnosis Anemia / epidemiology Mass Screening

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
06 2023
Historique:
received: 17 09 2022
revised: 06 02 2023
accepted: 13 02 2023
medline: 22 5 2023
pubmed: 23 2 2023
entrez: 22 2 2023
Statut: ppublish

Résumé

The role of gastroscopy to investigate the upper GI (UGI) tract in subjects with a positive fecal occult blood test (FOBT+) result is controversial. We conducted a systematic review and meta-analysis, which aimed to determine the prevalence of UGI lesions in FOBT+ subjects. Databases were searched until March 31, 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions (CSLs; lesions potentially explaining occult blood loss), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. We included 21 studies with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was .8% (95% CI, .4-1.6) and UGI CSLs was 30.4% (95% CI, 20.7-42.2), and that of colonic cancers and CSLs was 3.3% (95% CI, 1.8-6.0) and 31.9% (95% CI, 23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/without colonic pathology (ORs of 1.2 [95% CI, .9-1.6; P = .137] and 1.6 [95% CI, .5-5.5; P = .460]). Anemia in FOBT+ subjects was associated with UGI cancers (OR, 6.3; 95% CI, 1.3-31.5; P = .025) and UGI CSLs (OR, 4.3; 95% CI, 2.2-8.4; P = .0001). GI symptoms were not associated with UGI CSLs (OR, 1.3; 95% CI, .6-2.8; P = .511). There is an appreciable prevalence of UGI cancers and other CSLs in FOBT+ subjects. Anemia but not symptoms or colonic pathology are linked to UGI lesions. Although 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.

Sections du résumé

BACKGROUND AND AIMS
The role of gastroscopy to investigate the upper GI (UGI) tract in subjects with a positive fecal occult blood test (FOBT+) result 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 March 31, 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions (CSLs; lesions potentially explaining occult blood loss), odds ratio (OR), and 95% confidence intervals (CIs) were calculated.
RESULTS
We included 21 studies with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was .8% (95% CI, .4-1.6) and UGI CSLs was 30.4% (95% CI, 20.7-42.2), and that of colonic cancers and CSLs was 3.3% (95% CI, 1.8-6.0) and 31.9% (95% CI, 23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/without colonic pathology (ORs of 1.2 [95% CI, .9-1.6; P = .137] and 1.6 [95% CI, .5-5.5; P = .460]). Anemia in FOBT+ subjects was associated with UGI cancers (OR, 6.3; 95% CI, 1.3-31.5; P = .025) and UGI CSLs (OR, 4.3; 95% CI, 2.2-8.4; P = .0001). GI symptoms were not associated with UGI CSLs (OR, 1.3; 95% CI, .6-2.8; P = .511).
CONCLUSIONS
There is an appreciable prevalence of UGI cancers and other CSLs in FOBT+ subjects. Anemia but not symptoms or colonic pathology are linked to UGI lesions. Although 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.

Identifiants

DOI: 10.1016/j.gie.2023.02.013 PMID: 36812947
pubmed: 36812947
pii: S0016-5107(23)00260-2
doi: 10.1016/j.gie.2023.02.013
pii:
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1005-1015.e30

Informations de copyright

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Ayesha Shah (A)

Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Queensland, Australia.

Ali Eqbal (A)

Austin Hospital, Department of Gastroenterology & Hepatology, Melbourne, Victoria, Australia.

Naomi Moy (N)

Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Queensland University of Technology, School of Economics and Finance, Faculty of Business and Law, Centre for Behavioural Economics, Society and Technology, Queensland, Australia.

Natasha Koloski (N)

Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Queensland, Australia.

Helmut Messmann (H)

Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.

Bradley J Kendall (BJ)

Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.

Prateek Sharma (P)

Division of Gastroenterology and Hepatology, Veterans Affairs Medical Centre, University of Kansas School of Medicine, Kansas City, Missouri, USA.

Uwe Dulleck (U)

Queensland University of Technology, School of Economics and Finance, Faculty of Business and Law, Centre for Behavioural Economics, Society and Technology, Queensland, Australia; Crawford School of Public Policy, ANU; and CESifo LMU Munich, Munich, Germany.

Michael P Jones (MP)

School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.

Gerald J Holtmann (GJ)

Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Translational Research Institute, Queensland, Australia. Electronic address: g.holtmann@uq.edu.au.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Techniques d'investigation › Techniques de laboratoire clinique › Sang occulte › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Coloscopie › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Anémie › Upper GI endoscopy in subjects with positive...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Dépistage de masse › Upper GI endoscopy in subjects with positive...