Ng Jing Yu, Chan Dedrick Kok Hong, Tan Ker Kan
Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Int J Colorectal Dis. 2017 Jan;32(1):95-98. doi: 10.1007/s00384-016-2666-7. Epub 2016 Sep 30.
The use of fecal immunochemical test (FIT) in the screening for colorectal cancer is long established. However, more than 50 % of patients with positive FITs have a negative colonoscopy. The role of a subsequent oesophago-gastro-duodenoscopy (OGD) is debatable. The aim of this study is to evaluate the yield of OGD in patients with positive FITs.
A retrospective review of patients who underwent colonoscopy for a positive FIT between Jan. 2008 and Dec. 2012 was identified from a prospectively collected endoscopy database at the National University Hospital, Singapore. Patients who underwent concurrent or subsequent OGDs for positive FIT formed the study group. We considered any new cancer or significant upper gastrointestinal pathology such as peptic ulcer disease or gastritis requiring treatment as a positive examination.
A total of 202 patients underwent both a colonoscopy and an OGD for a positive FIT and formed the study group. One hundred and six (52.5 %) of them had a positive examination with gastritis and duodenitis representing the most common UGI pathology in 89 (44.1 %) patients. Twenty-nine (14.4 %) patients tested positive for helicobacter pylori infection and another 16 (7.9 %) patients had peptic ulcer disease. There were no UGI cancers detected. One patient had an esophageal leiomyoma that was treated conservatively.
Routine gastroscopy for FIT positivity has a high diagnostic yield for benign upper gastrointestinal pathology. Well-designed prospective studies to further evaluate the cost-effectiveness of routine gastroscopy in the work up of FIT positivity are warranted to make better clinical practice guidelines.
粪便免疫化学检测（FIT）用于结直肠癌筛查已有很长时间。然而，超过50%的FIT检测呈阳性的患者结肠镜检查结果为阴性。后续进行食管胃十二指肠镜检查（OGD）的作用存在争议。本研究的目的是评估FIT检测呈阳性的患者进行OGD检查的诊断率。
从新加坡国立大学医院前瞻性收集的内镜数据库中，回顾性分析2008年1月至2012年12月期间因FIT检测呈阳性而接受结肠镜检查的患者。因FIT检测呈阳性而同时或随后接受OGD检查的患者组成研究组。我们将任何新发现的癌症或需要治疗的重大上消化道病变，如消化性溃疡病或胃炎视为检查阳性。
共有202例患者因FIT检测呈阳性而同时接受了结肠镜检查和OGD检查，组成研究组。其中106例（52.5%）检查呈阳性，胃炎和十二指肠炎是最常见的上消化道病变，89例（44.1%）患者患有此病。29例（14.4%）患者幽门螺杆菌感染检测呈阳性，另有16例（7.9%）患者患有消化性溃疡病。未检测到上消化道癌症。1例患者患有食管平滑肌瘤，接受了保守治疗。
FIT检测呈阳性的患者进行常规胃镜检查对良性上消化道病变具有较高的诊断率。有必要进行精心设计的前瞻性研究，以进一步评估常规胃镜检查在FIT检测呈阳性患者检查中的成本效益，从而制定更好的临床实践指南。
