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Can J Gastroenterol. 2010 Feb;24(2):113-20.

Gastroscopy following a positive fecal occult blood test and negative colonoscopy: systematic review and guideline.

Author information

  • 1Department of Medicine, Division of Gastroenterology, University of Toronto, University Health Network-Toronto General Hospital, Toronto, Canada. johane.allard@uhn.on.ca

Abstract

BACKGROUND:

A sizeable number of individuals who participate in population-based colorectal cancer (CRC) screening programs and have a positive fecal occult blood test (FOBT) do not have an identifiable lesion found at colonoscopy to account for their positive FOBT screen.

OBJECTIVE:

To evaluate the evidence and provide recommendations regarding the use of routine esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancers in patients participating in a population-based CRC screening program who are FOBT positive and colonoscopy negative.

METHODS:

A systematic review was used to develop the evidentiary base and to inform the evidence-based recommendations provided.

RESULTS:

Nine studies identified a group of patients who were FOBT positive and colonoscopy negative. Three studies found no cases of UGI cancer. Four studies reported cases of UGI cancer; three found UGI cancer in 1% or less of the population studied, and one study found one case of UGI cancer that represented 7% of their small subgroup of FOBT-positive/colonoscopy-negative patients. Two studies did not provide outcome information that could be specifically related to the FOBT-positive/colonoscopy-negative subgroup.

CONCLUSION:

The current body of evidence is insufficient to recommend for or against routine EGD as a means of detecting gastric or esophageal cancers for patients who are FOBT positive/colonoscopy negative, in a population-based CRC screening program. The decision to perform EGD should be individualized and based on clinical judgement.

PMID:
20151070
PMCID:
PMC2852233
[PubMed - indexed for MEDLINE]
Free PMC Article
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