Limited Diagnostic Yield of Routine Gastroscopy in FIT-Positive Patients

Abstract

Background and aim: The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined. Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings. Methods: This retrospective study included 38,392 adults (≥18 years) who tested positive for FIT between 2016 and 2022 across eight medical centers in Israel. Of them, 1560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included the detection of neoplastic and precancerous lesions, with the rates of adenoma and polyp detection calculated. Gastroscopy findings, including gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy, were analyzed and compared between patients with normal and abnormal colonoscopy results. Results: Among 38,392 FIT-positive adults, 1560 underwent bidirectional endoscopy; of these, 632 (40.5%) had normal and 928 (59.5%) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.5% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 15% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Gastric ulcers were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group. Conclusions: Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare.

Keywords: FIT; abnormal colonoscopy; adenoma detection rate (ADR); colorectal cancer; gastroscopy; normal colonoscopy; polyp detection rate (PDR).

Figure 1

Bowel preparation type and quality. (a) The proportion of patients receiving different bowel preparation regimens. (b) The distribution of bowel preparation quality is categorized according to the Boston scale as intermediate, good, or very good.

Figure 2

Distribution of adenoma subtypes. Bar chart illustrating the distribution of adenoma subtypes detected in the study cohort, including tubular, tubulovillous, and villous adenomas.

Figure 3

Distribution of polyp count per patient. Bar chart showing the number of polyps detected per patient in the study cohort.

Figure 4

Prevalence of colorectal tumors and submucosal lesions. (a) The distribution of malignant colorectal tumors, including adenocarcinoma and carcinoid tumors, is presented as a percentage of the study population. (b) The prevalence of submucosal lesions, including lipomas and leiomyomas, is presented as a percentage of the total patient population.

Figure 5

Prevalence of colonic vascular and inflammatory conditions. Bar chart illustrating the percentage of patients diagnosed with Ulcerative colitis, Crohn’s disease, and angiodysplasia within the study cohort.

Figure 6

Proportion of patients undergoing colonoscopy alone versus combined colonoscopy and gastroscopy. Pie chart depicting the distribution of patients who underwent colonoscopy alone compared to those who underwent both colonoscopy and gastroscopy.

Figure 7

Distribution of upper gastrointestinal findings among patients undergoing gastroscopy. Bar chart illustrating the prevalence of various upper gastrointestinal conditions, including gastritis, hiatal hernia, esophagitis, duodenitis, reflux esophagitis, ulcers, and severe gastritis.

Figure 8

Proportion of normal and abnormal colonoscopy findings among patients undergoing colonoscopy and gastroscopy. Pie chart depicting the distribution of colonoscopy results, showing the proportion of patients with normal versus abnormal findings.

Figure 9

Comparison of normal and abnormal gastroscopy findings. Bar chart illustrating the distribution of various upper gastrointestinal conditions, categorized as normal or abnormal findings. Conditions include hernia, gastritis, esophagitis, duodenitis, ulcers, reflux esophagitis, and severe gastritis.