Jae Hee Cho

Is esophagogastroduodenoscopy necessary in patients with positive fecal occult blood tests and negative colonoscopy

Abstract Background. False positives of fecal occult blood tests (FOBT) regarding colorectal cancer detection are common. The aim was to investigate the upper gastrointestinal (GI) condition confirmed by endoscopy in positive FOBT patients without advanced colorectal neoplasia, hemorrhoid, or colitis. Methods. The authors reviewed the collective data of 340 positive FOBT patients who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy from January 2005 to October 2011. Demographic data, effects of medications, including antiplatelet agents, nonsteroidal anti-inflammatory drugs, or warfarin on the results of FOBT, presence or absence of GI mucosal lesions confirmed by EGD and colonoscopy, and FOBT titer in 552 positive FOBT patients were analyzed. Results. On colonoscopy, colorectal cancer was detected in 35 patients (10.3%), advanced adenoma in 22 patients (6.4%). “Negative colonoscopy” included no significant lesions and non-advanced adenomas. In 243 patients with “negative colonoscopy”, EGD findings included 3 (1.2%) gastric cancers and 39 (16%) peptic ulcer diseases. Gastric cancers were all found in patients who had no experience of EGD within 2 years; however, the incidence of peptic ulcer disease was not different in patients with or without previous EGD within 2 years. Two or more antiplatelet agents increased false positive rates of FOBT. Conclusions. Upper GI evaluation is mandatory in patients with positive FOBTs and negative colonoscopy especially in patients without experience of EGD within 2 years.

Diagnostic accuracy of narrow band imaging for predicting colon polyp histology can be affected by polyp characteristics.

BACKGROUND/AIMSnNarrow band imaging (NBI) is an optical endoscopic technique for predicting polyp histology during colonoscopy. However, it has not been elucidated the impact of polyp characteristics on the diagnostic capabilities of NBI. We aimed to evaluate which polyp characteristics can influence the diagnostic accuracy of NBI for discriminating neoplastic from non-neoplastic colorectal polyps.nnnMETHODOLOGYnA total of 232 colorectal polyps from 134 patients undergoing screening or surveillance colonoscopy were retrospectively analyzed. White light imaging (WLI) and NBI images of polyps were assessed by two experienced endoscopists and two trainees and then compared with histopathology.nnnRESULTSnWhen classified according to polyp morphology, NBI as well as WLI had a significantly lower sensitivity and diagnostic accuracy for non-polypoid lesions than for polypoid lesions in both experienced and trainee groups. In contrast, the specificity of NBI and WLI for non-polypoid lesions was higher than that for polpyoid lesions. As for polyp size, the diagnostic accuracy of NBI for polyps ≤5mm was significantly lower than for polyps of 6 to 9mm or ≤10mm in the experienced group.nnnCONCLUSIONSnNBI had a significantly lower diagnostic accuracy for predicting polyp histology in non-polypoid or diminutive colorectal lesions.