Fecal occult blood testing for the prediction of small-bowel pathology detected by capsule endoscopy: a systematic review and meta-analysis

Yung, Diana E; Vijayan, Sanju; Avni, Tomer; Douglas, Sarah; Kopylov, Uri; Koulaouzidis, Anastasios

doi:10.20524/aog.2017.0122

Cited by 6 publications

(9 citation statements)

References 22 publications

(50 reference statements)

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“…FIT has been proven to be useful in detecting colorectal pathology, however a significant proportion of false positives raises the possibility that it may also be useful in detection of small bowel lesions 13 . There is limited data on this topic, however a recent meta-analysis of six publications suggested FIT is not a good predictor of findings on SBCE 15 . In the meta-analysis, sensitivity and specificity of FIT in prediction of SB pathology were 0.48 and 0.60 respectively, both considerably lower than our trial (0.69 and 0.89 at > 45 ug Hb/g).…”

Section: Discussionmentioning

confidence: 99%

“…The studies included differed significantly from our trial, which may have contributed to this discrepancy. First, there were significant delays between analysis of FIT and completion of SBCE, in some cases up to 4 months 15 . In the meta-analysis, time between FIT to SBCE ranged between 3 days to 4 months, with an average lag of 1 to 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…A cut-off of 45 ug Hb/g feces (equivalent to 225 ng Hb/mL buffer) was chosen for our study, above which a FIT was deemed positive. This value was chosen as it is the standard cut-off used in the Irish National Bowel Screening Programme and is supported by international data as a cost-effective cut-off level 14 15 16 .…”

Section: Methodsmentioning

confidence: 99%

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Predicting pathology on small bowel capsule endoscopy: a good FIT

et al. 2019

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Background and study aims Small bowel capsule endoscopy [SBCE) has an established role in investigating suspected small bowel bleeding [SSBB). Identification of a biomarker to predict pathology would maximize utility of this valuable diagnostic modality. This study aimed to investigate if fecal immunochemical test [FIT) could predict likelihood of small bowel pathology on SBCE. Patients and methods Patients referred for SBCE to investigate anaemia or suspected small bowel bleeding were prospectively recruited. All patients had negative upper and lower endoscopy prior to referral. A FIT ≥ 45 ug Hb/g was considered positive. SBCE was positive if a potential source of SSBB was identified. The primary endpoint was correlation between FIT and positive SBCE. Secondary endpoints were correlation between anemia and SBCE and a combination of anemia plus FIT and SBCE. Results Fifty-one patients were included in the final study cohort. 29.4 % had a positive FIT, 33.3 % were anemic, and 25.5 % patients had significant SBCE findings. There was a statistically significant association between positive FIT and pathology on SBCE (OR 12, 95 % CI [2.8 – 51.9), P = 0.001). Sensitivity and specificity of positive FIT in predicting SBCE findings were 69 % and 84 %, respectively. A normal Hb had an NPV of 83 % (OR 0.30, P = 0.09). Combining Hb and FIT was statistically significant in predicting pathology on SBCE (OR 9.14, 67 % PPV, 82 % NPV, P = 0.025). Conclusion FIT ≥ 45 ug Hb/g is a useful tool in predicting small bowel pathology on SBCE. Use of this biomarker alone, or in combination with serum haemoglobin, has value as a screening tool and may help to better triage patients referred for SBCE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predicting pathology on small bowel capsule endoscopy: a good FIT

et al. 2019

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“…These tests are based on the concept of detecting blood or shredded cell debris from vascularized polyps, adenomas and cancers. Owing to their simplicity and user-friendliness, gFOBT and FIT have found widespread use in CRC screening but are burdened by low sensitivity and specificity [ 5 ]. Invasive tests include flexible sigmoidoscopy and colonoscopy, have higher sensitivity and specificity because they offer direct visualization and pathology specimen collection [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Plasma cytokine levels and the presence of colorectal cancer

et al. 2019

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Background/AimsCancer-related activation of cytokine networks are central aspects of tumor development. The goal of the study was to examine the possibility of plasma cytokines for the screening of colorectal cancer (CRC).MethodsWe carried out a multicenter, hospital-based case-control study in 66 adult Japanese patients with CRC and 87 healthy adult Japanese. A multiplex bead array immunoassay was used to examine 27 different plasma cytokines. Their association with the presence of CRC was evaluated by logistic regression analysis after adjusting for potential confounding factors.ResultsThirteen plasma cytokines were notably associated with the presence of CRC (p< 0.05). Receiver operating characteristic analysis revealed that the combinatorial assessment of some of these plasma cytokines showed “good” capability for discriminating between CRC patients and control subjects (area under the curve (AUC): 0.819 for the combination of IL-9, Eotaxin, G-CSF, and TNF-α; 0.832 for the combination of IL-4, IL-8, Eotaxin, IP-10, and TNF-α). Individual cytokine assessments presented lower AUCs (0.657–0.755) than the combinatorial cytokine assessments.ConclusionsThe levels of several plasma cytokines varied significantly between CRC patients and control subjects, suggesting the possibility of differentially expressed plasma cytokines as potential biomarkers for detecting the presence of CRC. Our results should be validated in other populations.

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“…The fecal immunochemical test (FIT) is used widely in colorectal cancer screening. A 2017 small systematic review showed a low sensitivity and specificity of FIT for significant findings on CE where FIT used as a selection tool for SBCE showed a sensitivity of 0.48 and a specificity of 0.60; i.e., neither a positive nor a negative FIT were good predictors of SB findings on CE [12]. However, more recent data provided by our colleagues have suggested FIT to be a useful biomarker in predicting the likelihood of small bowel pathology in patients with anemia.…”

Section: Biomarkersmentioning

confidence: 99%

Small-Bowel Capsule Endoscopy—Optimizing Capsule Endoscopy in Clinical Practice

O'Hara

McNamara

2021

Diagnostics

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The small bowel is the longest organ within the gastrointestinal tract. The emergence of small bowel capsule endoscopy (SBCE) over the last 20 years has revolutionized the investigation and diagnosis of small bowel pathology. Its utility as a non-invasive and well-tolerated procedure, which can be performed in an outpatient setting, has made it a valuable diagnostic tool. The indications for SBCE include obscure gastrointestinal bleeding, small bowel Crohn’s disease, and, less frequently for screening in polyposis syndromes, celiac disease, or other small bowel pathology. Currently, there are several small bowel capsules on the market from different manufacturers; however, they share many technological features. The European Society of Gastrointestinal Endoscopy (ESGE) only recently developed a set of key quality indicators to guide quality standards in this area. Many of the technical aspects of capsule endoscopy still feature a degree of uncertainty in terms of optimal performance. Incomplete studies due to slow transit through the bowel, poor imaging secondary to poor preparation, and the risk of capsule retention remain frustrations in its clinical utility. Capsule review is a time-consuming process; however, artificial intelligence and machine learning offer opportunities to improve this. This narrative review examines our current standing in a number of these aspects and the potential to further the application of SBCE in order to maximize its diagnostic utility.

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Fecal occult blood testing for the prediction of small-bowel pathology detected by capsule endoscopy: a systematic review and meta-analysis

Cited by 6 publications

References 22 publications

Predicting pathology on small bowel capsule endoscopy: a good FIT

Predicting pathology on small bowel capsule endoscopy: a good FIT

Plasma cytokine levels and the presence of colorectal cancer

Small-Bowel Capsule Endoscopy—Optimizing Capsule Endoscopy in Clinical Practice

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