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Upper Gastrointestinal Endoscopy in Subjects with Positive Faecal Occult Blood Test Undergoing Colonoscopy: Systematic Review and Meta-Analysis

  • Author Footnotes
    $ Ayesha Shah and Ali Eqbal share equal first co-authorship.
    ,
    Author Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Ayesha Shah
    Footnotes
    $ Ayesha Shah and Ali Eqbal share equal first co-authorship.
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Affiliations
    The University of Queensland, Faculty of Medicine, QLD, Australia

    Princess Alexandra Hospital, Department of Gastroenterology & Hepatology, QLD, Australia

    Translational Research Institute, QLD, Australia
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  • Author Footnotes
    $ Ayesha Shah and Ali Eqbal share equal first co-authorship.
    Ali Eqbal
    Footnotes
    $ Ayesha Shah and Ali Eqbal share equal first co-authorship.
    Affiliations
    Austin Hospital, Department of Gastroenterology & Hepatology, Melbourne, Australia
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  • Naomi Moy
    Affiliations
    Princess Alexandra Hospital, Department of Gastroenterology & Hepatology, QLD, Australia

    Queensland University of Technology, School of Economics and Finance, Faculty of Business and Law, Centre for Behavioural Economics, Society and Technology, Queensland, Australia
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  • Author Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Natasha Koloski
    Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Affiliations
    The University of Queensland, Faculty of Medicine, QLD, Australia

    Princess Alexandra Hospital, Department of Gastroenterology & Hepatology, QLD, Australia

    Translational Research Institute, QLD, Australia
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  • Helmut Messman
    Affiliations
    Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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  • Bradley J. Kendall
    Affiliations
    The University of Queensland, Faculty of Medicine, QLD, Australia

    Princess Alexandra Hospital, Department of Gastroenterology & Hepatology, QLD, Australia
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  • Prateek Sharma
    Affiliations
    Division of Gastroenterology and Hepatology, Veterans Affairs Medical Centre, University of Kansas School of Medicine, Kansas City, Missouri, USA
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  • Uwe Dulleck
    Affiliations
    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, Germany
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  • Author Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Michael P. Jones
    Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Affiliations
    Macquarie University, School of Psychological Sciences, Sydney, NSW, Australia
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  • Author Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Gerald Holtmann
    Correspondence
    Corresponding Author: Gerald J. Holtmann, MD, PhD, MBA, FRACP, FRCP, FAHMS, Professor of Medicine, Princess Alexandra Hospital, Brisbane, Department of Gastroenterology and Hepatology & University of Queensland, Ipswich Road, Woolloongabba, Queensland, Australia, , Phone +61 424 956 000, Facsimile +61 7 3176 5111
    Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    Affiliations
    The University of Queensland, Faculty of Medicine, QLD, Australia

    Princess Alexandra Hospital, Department of Gastroenterology & Hepatology, QLD, Australia

    Translational Research Institute, QLD, Australia
    Search for articles by this author
  • Author Footnotes
    ∗ for AGIRA (Australian Gastrointestinal Research Alliance)
    $ Ayesha Shah and Ali Eqbal share equal first co-authorship.
Published:February 19, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.013
Upper Gastrointestinal Endoscopy in Subjects with Positive Faecal Occult Blood Test Undergoing Colonoscopy: Systematic Review and Meta-Analysis
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      This paper is only available as a PDF. To read, Please Download here.

      ABSTRACT:

      Background and Aims

      The role of gastroscopy to investigate the upper gastrointestinal (UGI) tract in subjects with positive faecal occult blood test (FOBT+) 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 April 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions ((CSL), lesions potentially explaining occult blood loss)), Odds Ratio (OR) and 95% confidence intervals (CI) were calculated.

      Results

      We included 21 studies, with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was 0.8% (95%CI0.4-1.6) and UGI CSL was 30.4% (95%CI20.7-42.2), while that of colonic cancers and CSL was 3.3% (95%CI1.8-6.0) and 31.9% (95%CI23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/ without colonic pathology, (OR=1.2, 95%CI0.9-1.6, p=0.137, and OR=1.6, 95%CI0.5-5.5, p=0.460, respectively). Anaemia in FOBT+ subjects was associated with UGI cancers (OR=6.3, 95%CI1.3-31.5, p=0.025) and UGI CSL (OR=4.3, 95%CI2.2-8.4, p=0.0001). Gastrointestinal symptoms were not associated with UGI CSL (OR=1.3, 95%CI 0.6-2.8, p=0.511).

      Conclusions

      In FOBT+ subjects there is an appreciable prevalence of UGI cancers and other CSL. Anaemia but not symptoms or colonic pathology are linked to UGI lesions. While 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.

      Key words

      Acronyms and abbreviations:

      UGI (Upper gastrointestinal), FOBT (faecal occult blood test), CSL (clinically significant lesions), OR (Odds ratio), CI (confidence intervals), CRC (Colorectal cancer), gFOBTs (guaiac based FOBTs), FITs (faecal immunochemical tests), PRISMA (Preferred reporting items for systematic reviews and meta-analysis statement requirements), JBI (Joanna Briggs Institute), CMA (Comprehensive Meta-Analysis)
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      Article info

      Publication history

      Accepted: February 13, 2023
      Received in revised form: February 6, 2023
      Received: September 17, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Manuscript prepared for Gastrointestinal Endoscopy

      Acknowledgements: The authors would like to acknowledge our Librarian, Ms Gina Velli who has assisted with the literature search.

      Writing Assistance: None

      Guarantor or article: Prof Gerald Holtmann

      Author contributions:

      Ayesha Shah, Ali Eqbal and Gerald Holtmann - study idea, concept and design, data extraction and interpretation of data, drafting of the manuscript. Ali Eqbal and Ayesha Shah share equal first co-authorship.

      Natasha Koloski - drafting of the manuscript and review of final manuscript.

      Prateek Sharma - drafting of the manuscript and review of final manuscript.

      Helmut Messman - drafting of the manuscript and review of final manuscript.

      Bradley J Kendall - drafting of the manuscript and review of final manuscript.

      Uwe Dulleck - drafting of the manuscript and review of final manuscript.

      Naomi Moy - data analysis, drafting of the manuscript and review of final manuscript.

      Mike Jones - data analysis, drafting of the manuscript and review of final manuscript.

      Funding: National Health and Medical Research Council (APP1084544), Centre for Research Excellence (APP170993.)

      Financial Support: Nil

      Conflict of Interest:

      GH report to be on the advisory boards Australian Biotherapeutics, Glutagen, Bayer and received research support from Bayer, Abbott, Pfizer, Janssen, Takeda, Allergan. He serves on the Boards of the West Moreton Hospital and Health Service, Queensland, UQ Healthcare, Brisbane and the Gastro-Liga, Germany. He has a patent for the Brisbane aseptic biopsy device and serves as Editor of the Gastro-Liga Newsletter.

      Other co-authors: None

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.013

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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