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.
Austin Hospital, Department of Gastroenterology & Hepatology, Melbourne, Victoria, Australia.
Gastrointest Endosc. 2023 Jun;97(6):1005-1015.e30. doi: 10.1016/j.gie.2023.02.013. Epub 2023 Feb 20.
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.
对于粪便潜血试验（FOBT）阳性的患者，行胃镜检查以探查上消化道（UGI）的作用存在争议。本研究进行了系统评价和荟萃分析，旨在确定 FOBT 阳性患者 UGI 病变的发生率。
检索数据库至 2022 年 3 月 31 日，以获取报告行结肠镜和胃镜检查的 FOBT 阳性患者 UGI 病变的研究。计算 UGI 癌和临床显著病变（CSL；可能解释潜血丢失的病变）的汇总患病率、比值比（OR）和 95%置信区间（CI）。
共纳入 21 项研究，包含 6993 例 FOBT 阳性患者。UGI 癌的汇总患病率为 0.8%（95%CI，0.4-1.6），UGI CSL 为 30.4%（95%CI，20.7-42.2），结直肠癌和 CSL 分别为 3.3%（95%CI，1.8-6.0）和 31.9%（95%CI，23.9-41.1）。FOBT 阳性且伴有/不伴有结直肠病变患者的 UGI CSL 和 UGI 癌的患病率无显著差异（CSL：OR 1.2[95%CI，0.9-1.6；P=0.137]，UGI 癌：OR 1.6[95%CI，0.5-5.5；P=0.460]）。FOBT 阳性患者贫血与 UGI 癌（OR，6.3；95%CI，1.3-31.5；P=0.025）和 UGI CSL（OR，4.3；95%CI，2.2-8.4；P=0.0001）相关。GI 症状与 UGI CSL 无关（OR，1.3；95%CI，0.6-2.8；P=0.511）。
FOBT 阳性患者中 UGI 癌和其他 CSL 的发生率相当高。贫血但非症状或结直肠病变与 UGI 病变相关。尽管数据表明，结肠镜联合胃镜检查可使 FOBT 阳性患者的恶性肿瘤检出率比单独结肠镜检查增加约 25%，但仍需要前瞻性数据来确定将双内镜作为所有 FOBT 阳性患者的标准治疗方案的成本效益。
