GGK Testi Pozitifliğine Bağlı Tarama Kolonoskopileri Normal Saptanan Hastalarda Üst GİS Endoskopisi Uygulanmalı Mı?

Amaç: Gaitada gizli kan (GGK) testi kolorektal kanser taramasında kullanılmaktadır. GGK testi pozitif olan ancak kolonoskopisi normal olan hastalarda üst gastrointestinal sistem (GİS) endoskopisi yapılması gerekliliği tartışma konusudur. Bu çalışmanın amacı, GGK testi pozitif olan hastalara yapılan eş zamanlı alt ve üst GİS endoskopi sonuçlarında kolonoskopisi normal olan hangi hasta grubuna üst GİS endoskopisi önerilmesi gerektiğinin araştırılmasıdır. Gereç ve Yöntem: Ocak 2017- Mart 2020 tarihleri arasında GGK testi pozitifliği nedeniyle aynı seansta alt ve üst GİS endoskopisi yapılan hastalar retrospektif olarak tarandı. Taranan 626 hastadan kolonoskopisi normal olan 379 kişi çalışmaya dahil edildi. Hastaların demografik özellikleri, endoskopi bulguları, patoloji sonuçları ve hemoglobin değerleri hastane kayıtlarından incelendi. Bulgular: GGK testi pozitif olup kolonoskopisi normal olan 379 hastadan 139 (% 36,6)’u erkek ve yaş ortalaması 57,7 (18-88) idi. H. pylori %46 hastada pozitif, %35 hastada negatif idi ve %19 hastada bakılmamıştı. Gastrik polip 6 hastada saptandı ve bu hastaların 4’ünde H. pylori pozitifliği mevcuttu. 5 hastada mide malignitesi tespit edildi. Benign patolojilerin %13’ünü polip, varis, ülser ve %46’sını H. pylori pozitifliği gibi takip gerektiren hastalıklar oluşturmaktaydı. Hemoglobin düşüklüğü istatistiksel olarak anlamlı olmasa da tümör grubunda diğer tanı alan hastalara göre daha düşüktü (8,4 g/dL vs 11,8 g/dL). Sonuç: Çalışmamızda üst GİS endoskopisinde hastaların %13’ünde tümörün yanı sıra polip, varis, ülser ve %46’sında H. pylori pozitifliği gibi takip gerektiren benign patolojiler de tespit edilmiştir. Bu nedenle GGK testi pozitif olan ve kolonoskopisinde patoloji saptanmayan hastalara üst GİS endoskopisi yapılması önerilmelidir.

Should Upper GIS Endoscopy Be Applied in Patients with Normal Screening Colonoscopies Due to FOB Test Positivity?

Objective: The fecal occult blood (FOB) test is used for colorectal cancer screening. The necessity of upper gastrointestinal system (GIS) endoscopy in patients with positive FOB test after normal colonoscopy is controversial. The aim of this study is to investigate whether lower and upper GIS endoscopy should be performed together in patients with positive FOB test. Material and Method: Lower and upper GIS endoscopy at same session for FOB test positivity were retrospectively evaluated in the endoscopic intervention data between January 2017-March 2020. Out of 626 patients, 379 with positive FOB and normal colonoscopy were included the study. The data on demographic characteristics, endoscopy findings, pathology results and hemoglobin values were collected from the hospital records. Results: By FOB Test positive patients with normal colonoscopy 36,6% were male, and the mean age was 57.7 (18-88). H. pylori was positive in 46%, negative in 35%, and was not examined in 19% patients. Gastric polyp was detected in 6 patients and 4 of them were H. pylori positive. Gastric malignancies were detected in 5 patients. Thirteen percent of benign pathologies were detected as polyp, varicosis, ulcer and 46% had H. pylori positivity which were requiring follow-up. Although statistically not significant, the mean hemoglobin level was lower in the tumor group (8,4 g/dL vs 11,8 g/dL). Conclusion: In our study, benign pathologies requiring follow-up such as polyps, varicose veins, ulcers were detected as 13%, and H. pylori positivity was present in in 46% of the patients in addition to tumors in upper GIS endoscopy. Therefore, upper GIS endoscopy must be recommended to patients with positive FOB test even if the colonoscopy is normal.

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