Aim: Prior studies have reported conflicting results on the yield of esophagogastroduodenoscopy (EGD) in patients with a positive fecal occult blood test (FOBT). Our aim was to compare the yield between EGD and colonoscopy performed in a racially diverse population with a positive FOBT.
Methods: A retrospective, cross-sectional study of FOBT positive patients who underwent EGD and colonoscopy from January 1, 1999 to November 1, 2008. Endoscopic lesions deemed responsible for GI bleeding were identified.
Results: Two hundred and eighty-seven patients met entry criteria, among which, 63% were Asian and 81% were immigrants to the U.S. Forty-four patients had EGD findings deemed responsible for a positive FOBT, the most common being esophagitis (25.0%) and gastric ulceration (15.9%). Forty-two patients had colonoscopic findings likely responsible for a positive FOBT with the most frequent lesion being colonic polyps ≥9 mm in diameter (76.2%). Prevalence of lower and upper GI tract lesions responsible for positive FOBT was similar (14.6% vs. 15.3%, p = 0.2). There was no association between a patient reporting upper GI symptoms, or the presence of anemia and the detection of upper GI tract lesions on endoscopy. Gastric adenocarcinoma (n = 3) was as prevalent as colorectal adenocarcinoma (n = 4). All three patients with gastric adenocarcinomas were Asian (prevalence 1.6%).
Conclusions: In our racially diverse population evaluated for a positive FOBT, gastric adenocarcinoma was as prevalent as colorectal adenocarcinoma; however, gastric adenocarcinoma was limited to Asian patients. EGD and colonoscopy should be considered in the evaluation of patient populations similar to ours, particularly Asian immigrants.