Altaib Al Yassin, MD, DO, MS1, Lidia Sapho, MD2, Joan Kheder, MD2, Yasir Alazzawi, MD, MPH1
1University of Massachusetts Medical School, Worcester, MA; 2University of Massachusetts Medical Center, Worcester, MA
Introduction: Cancers of the esophagus and stomach are among the most lethal of all malignancies. The majority of these neoplasms are detected at an advanced stage due to their similarity in early stages to benign causes of dysphagia and dyspepsia. It has been suggested that fecal immunochemical testing (FIT) could be used for population-based screening for occult bleeding caused by colorectal cancer. However, the diagnostic sensitivity of these tests has been difficult to estimate. A positive FIT might also come from the upper gastrointestinal (GI) tract, so perhaps we should consider esophagogastroduodenoscopy (EGD), or Video capsule endoscopy (VCE) to detect upper GI cancers. We aimed to determine how many individuals are found to have upper GI cancers (esophageal, gastric, or small bowel cancer) in EGD or VCE after a positive FIT, and to see whether using FIT can predict the risk of cancer in patients.
Methods: A retrospective chart review of patients who were referred to a GI clinic in an academic center between 2006 and 2016, had a positive FIT, and followed by EGD or/and VCE. Patients’ data including age, race, gender, in addition to the indication of EGD and VCE, and endoscopic findings were reviewed and collected.
Results: A total of 206 patients who had positive FIT. Of whom, 181 patients had EGD and 25 and had VCE. The mean age of the patients was 62 years with 94% above 50 years old. The most common indication for the EGD and VCE was gastrointestinal bleeding followed by dyspepsia and positive FIT. Abnormal endoscopic findings were found in 143 EGD and 19 VCE representing collectively 78% of the studies. Of the 172 endoscopic evaluation of the upper gastrointestinal tract, 1 patient was found to have cancer and 142 patients to have benign findings. The most common benign conditions were gastritis/duodenitis (63%) followed by esophagitis (22%) and peptic ulcers disease (12%). Positive predictive value of FIT for non-malignant lesions was found to be 79%.
Discussion: There is a high diagnostic value of positive FIT especially for patients older than 50 years. EGD and VCE evaluations after a positive FIT had a high yield of non-malignant lesions.
Citation: Altaib Al Yassin, MD, DO, MS; Lidia Sapho, MD; Joan Kheder, MD; Yasir Alazzawi, MD, MPH. P0403 - DIAGNOSTIC VALUE OF FIT IN UPPER GASTROINTESTINAL MALIGNANCY. Program No. P0403. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.