Aims The French screening program for colorectal cancer is based on a fecal immunological
test (FIT), followed by colonoscopy in case of its positivity. The interest of adding
a concomitant upper endoscopy, to detect upper digestive lesions (precancerous or
others), is still debated. We aimed to evaluate the frequency of upper digestive lesions
detected by upper endoscopy, performed concomitantly with colonoscopy for positive
FIT, and their impact on the management of patients (i.e. surveillance, medical treatment,
endoscopic or surgical procedure).
Methods Data of all patients who consulted for a positive FIT between May 2016 and May 2019
in our center, and for whom concomitant upper endoscopy and colonoscopy were performed,
were analyzed retrospectively. Patients with significant history of upper gastrointestinal
disease, or active gastrointestinal symptoms were excluded.
Results One hundred patients were included (median age (min-max): 62 (50–75), men 64%). Macroscopic
and/or microscopic upper digestive lesions were found in 58 of them (58%): Helicobacter pylori infection in 17 patients, gastric precancerous lesions in 9 patients (chronic atrophic
gastritis with intestinal metaplasia, n = 8; low grade dysplasia n = 1), and Barrett’s
esophagus requiring surveillance in 4 patients. The impact on the patients´ management
was of 44% (n = 44/100), with no significant difference between the groups with positive
or negative colonoscopy.
Conclusions A systematic upper endoscopy coupled with colonoscopy for positive FIT could represent
an efficient strategy for upper digestive lesions screening in France as it reveals
macroscopic and/or microscopic lesions in over 50% of patients, precancerous lesions
in over 10% of patients, and has an overall impact on the management in over 40% of
patients. Further studies are necessary to confirm these results and to evaluate cost-effectiveness
of this approach.
