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.