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

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


Background Fecal occult blood testing (FOBT) has been suggested as a potential screening tool for small-bowel capsule endoscopy (CE). We conducted a meta-analysis of studies correlating FOBT and CE findings to examine the predictive value of positive FOBT for CE findings.

Methods PubMed and Embase search. Sensitivity, specificity and diagnostic odds ratios (DORs) were calculated.

Results Six studies were identified. Four used fecal immunochemical testing (FIT), one used FIT and guaiac FOBT, one used hemoglobin/haptoglobin complex testing (Hb/Hpt). Five of the 6 studies were suitable for statistical analysis. For all positive FOBT, sensitivity for small-bowel findings was 0.60 (95%CI 0.50-0.69), specificity was 0.72 (95%CI 0.52-0.86), and DOR was 3.96 (95%CI 1.50-10.4). For the 4 studies using only FIT, sensitivity was 0.48 (95%CI 0.36-0.61), specificity was 0.60 (95%CI 0.42-0.76), and DOR was 1.41 (95%CI 0.72-2.75).

Conclusions Although a number of modalities have been suggested for screening small-bowel CE referrals, none of them, including FOBT, offer a comprehensive solution. Further work is required to refine screening methods for small-bowel CE referrals.

Keywords Capsule endoscopy, fecal occult blood test, fecal immunochemical test, small bowel, meta-analysis, systematic review

Ann Gastroenterol 2017; 30 (2): 186-191

Original Articles