Is a fecal occult blood test a useful tool for judging whether to perform capsule endoscopy in low-dose aspirin users with negative colonoscopy and esophagogastroduodenoscopy?

Abstract

Small bowel evaluation using CE is not recommended for FIT-negative, low-dose aspirin users. However, small bowel evaluation using CE should be considered in both FIT-positive and anemic low-dose aspirin users.

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

“…When we examined studies where only FIT produced by Eiken Chem was used [ 10 , 13 - 15 ], we obtained a sensitivity of 0.59 (95%CI 0.47-0.70), a specificity of 0.76 (95%CI 0.51-0.91) and a DOR of 4.51 (95%CI 1.36-15.7). When only prospective studies were included [ 5 , 10 , 14 , 15 ], the sensitivity was 0.58 (95%CI 0.46-0.69), specificity was 0.75 (95%CI 0.49-0.90), and DOR was 4.10 (95%CI 1.14-14.8).…”

“…Six studies [ 5 , 10 , 12 - 15 ] were included for review, with a total of 607 patients (380 male/227 female). Four [ 10 , 12 - 14 ] used FIT (Eiken Chem, Tokyo, Japan), with an Hb cutoff of 100 ng/mL; one [ 5 ] used both FIT (Onsight, Laboratory diagnostics; cutoff 100 ng/mL) and gFOBT (Stanbio, Laboratory diagnostics); and one [ 15 ] used the Hb/haptoglobin (Hpt) complex test (Eiken Chem, Tokyo, Japan) with a cutoff of 0.1 ng/mL. All studies were published between 2011 and 2016.…”

“…All studies were published between 2011 and 2016. Four [ 10 , 12 , 13 , 15 ] were carried out in Japan, one [ 5 ] in Australia and one [ 14 ] in Israel; all were single-center studies. Moreover, all but one [ 13 ] of the studies were prospective.…”

“…A further keyword search for “capsule endoscopy” AND “fecal occult blood” was conducted in Google Scholar, turning up one more article [ 10 ], available online whilst awaiting print publication. A flowchart detailing the search and selection process is presented in Fig.…”

Prevalence of Gastric and Small-Intestinal Mucosal Injury in Elderly Patients Taking Enteric-Coated Aspirin by Magnetically Controlled Capsule Endoscopy

“…Furthermore, aspirin significantly increases the risks of gastric injury, ulceration, and serious bleeding, particularly in elderly individuals [5]. The introduction of capsule endoscopy (CE) and double-balloon enteroscopy has increased the rate of detection of aspirin-related small-intestinal mucosal injury [6–9]. The recent development of magnetically controlled capsule endoscopy (MCCE) combining examination of the upper gastrointestinal tract and small intestine can detect more diagnostic yield than esophagogastroduodenoscopy alone in patients with recurrent or refractory iron deficiency anemia [10], correctly predict safe discharge for patients with acute upper gastrointestinal bleeding [11], and also enable simultaneous screening for aspirin-related gastric and small-intestinal mucosal injuries [12].…”