SJG：上消化道内镜检查对便潜血阳性而结肠镜检查阴性的患者是必要的？

　　来自韩国的Ja Sung Choi医生及其同事通过内镜研究便潜血阳性患者的上消化道情况，这些患者无晚期结直肠肿瘤、痔疮或结肠炎。

　　这个团队回顾分析了从2005-2011年间进行上消化道及结肠镜检查的340名便潜血阳性患者的总体资料。

　　研究分析了552名便潜血阳性患者的人口资料，药物的影响，包括抗血小板药、非甾体类抗炎药或华法令对便潜血实验结果的影响，经上消化道镜和结肠镜确定的消化道黏膜病灶，及便潜血实验的效价。

　　结肠镜检查中，发现35名结直肠癌患者，22名高级别腺瘤患者。“结肠镜检阴性”包括无明显病灶及非高级别腺瘤存在。

　　研究者发现在243名“结肠镜检阴性”患者中，上消化道镜检发现3例胃癌和39例胃溃疡病。胃癌均发生于2年内未进行上消化道镜检的患者。然而，胃溃疡病的发病率在2年中是否进行上消化道镜检的患者间无明显差异。研究者观察到有2种或更多抗血小板药物增加便潜血实验的假阳性率。

　　Choi医生的团队总结到：“对于便潜血阳性及结肠镜检阴性的患者，上消化道情况的评估极其必要，尤其是2年内未行上消化道镜检的患者”。

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