Digital rectal examination versus spontaneous passage of stool for fecal occult blood testing.

BACKGROUND: The diagnostic value of a positive fecal occult blood test (FOBT) at the time of digital rectal examination (DRE) is disputed despite being used commonly by a significant number of physicians. A meta-analysis was conducted to evaluate FOBT by DRE for detecting neoplasia versus FOBT on stool passed spontaneously (SPS) in asymptomatic patients undergoing colorectal cancer screening. METHODS: MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane database of systematic reviews, CINAHL, PubMed, and recent abstracts from major conferences were searched in August 2011. We included all of the studies that compared stool sampling techniques for FOBT. Separate analyses were performed for each main outcome (normal, nonadvanced adenoma, advanced adenoma, and colon cancer). RESULTS: Seven studies (N = 1835) met the inclusion criteria. The use of DRE for FOBT demonstrated statistically significant fewer advanced adenomas than SPS for FOBT. No statistically significant differences were noted for normal findings, neoplasia, nonadvanced adenoma, or colon cancer with DRE compared with SPS for FOBT. CONCLUSIONS: DRE for FOBT appears to be less effective at detecting advanced adenomas as compared with SPS despite cancer detection being similar. FOBT by SPS appears to be statistically superior to FOBT by DRE.

Warfarin Use During Fecal Occult Blood Testing: A Meta-Analysis.

BACKGROUND: Fecal occult blood testing (FOBT) is a widely used screening test for colorectal cancer (CRC). Given the limited data about the effects of warfarin on FOBT are inconclusive, current screening guidelines for CRC do not address whether warfarin should be discontinued before FOBT. Therefore, we conducted a meta-analysis to evaluate the influence of warfarin on the yield of FOBT. METHODS: Multiple medical databases were searched (April 2011). Studies examining the use of warfarin versus no warfarin for FOBT were included. Meta-analysis for the effect of warfarin or no warfarin for FOBT was performed by calculating pooled estimates of colonoscopy findings and detection of neoplasia, any adenoma, advanced adenoma, or colon cancer by odds ratio (OR) with fixed and random effects model. RevMan 5.1 was utilized for statistical analysis. RESULTS: Five studies (N = 11,244) met the inclusion criteria. No statistically significant difference was noted between FOBT with or without warfarin for colonoscopy findings (OR 0.88; 95% CI: 0.48 - 1.62, P = 0.67) or detection of neoplasia (OR 0.88; 95% CI: 0.58 - 1.35, P = 0.57), any adenoma (OR 1.08; 95% CI: 0.73 - 1.58, P = 0.71), advanced adenoma (OR 1.07; 95% CI: 0.69 - 1.65, P = 0.78), and colon cancer (OR 0.69; 95% CI: 0.38 - 1.23, P = 0.21). CONCLUSIONS: Among patients with positive FOBT, the yield of colonoscopy appears not to be altered by warfarin use.