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

Yung DE, Vijayan S, Avni T et al.

Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Diana Yung, Sarah Douglas, Anastasios Koulaouzidis).

Annals of gastroenterology. 2017.

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