The Role of UGI Endoscopy in the Workup of Patients With a Positive Cologuard Test in an Appalachian Population

IntroductionColorectal cancer is the third leading cause of cancer incidence and mortality in the U.S. Screening has contributed to a 2% annual decline in incidence and deaths. The Cologuard test is approved for average-risk patients 45 and older and, when positive, mandates follow-up colonoscopy. However, false positives range from 13% to 40%. There is ongoing debate about the utility of adding upper gastrointestinal (UGI) endoscopy to the workup of a positive Cologuard test, despite its utility in diagnosing conditions like peptic ulcer disease. This study explores the potential benefits of including UGI endoscopy to the work up of positive Cologuard patients in an Appalachian population.Methods100 consecutive patients with positive Cologuard tests underwent bidirectional endoscopy by the same surgeon. The study was conducted in an Appalachian region with high levels of tobacco and alcohol use. Positive findings included severe UGI inflammation, erosions, ulcers, and colon polyps or tumors larger than 5 mm.ResultsThe study analyzed endoscopic findings on 100 consecutive patients. Only 52% of positive Cologuard patients had positive findings on colonoscopy. 70% of patients had significant findings on UGI endoscopy. 28% had positive findings on both upper and lower endoscopy and 6% had normal upper and lower endoscopy.ConclusionThis study suggests that UGI endoscopy may be a beneficial component of the workup for positive Cologuard tests in certain high-risk populations. This practice could identify significant pathology and improve early detection of conditions like peptic ulcers and early cancers, thereby enhancing patient outcomes.