Download PDF
Thorac Cardiovasc Surg 2024; 72(01): 021-028
DOI: 10.1055/a-2052-8912
Original Cardiovascular

Fecal Occult Blood Screening before Cardiac Surgery

Yoshiyuki Takami 
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Atsuo Maekawa
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Koji Yamana
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Kiyotoshi Akita
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Kentaro Amano
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Yusuke Sakurai
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
,
Yasushi Takagi
1   Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Background Concerns of gastrointestinal (GI) bleeding after cardiac surgery are increasing with increased use of antiplatelets and anticoagulants. We investigated the roles of preoperative screening for fecal occult blood by fecal immunochemical test (FIT) widely used to detect GI bleeding and cancer.

Methods A retrospective review was done in 1,663 consecutive patients undergoing FIT before cardiac surgery between years 2012 and 2020. One or two rounds of FIT were performed 2 to 3 weeks before surgery, when antiplatelets and anticoagulants were not suspended yet.

Results Positive FIT (> 30 μg of hemoglobin/g of feces) was observed in 227 patients (13.7%). Preoperative risk factors for positive FIT included age > 70 years, anticoagulants, and chronic kidney disease. Of those with positive FIT, 180 patients (79%) received preoperative endoscopy, including gastroscopy (n = 139), colonoscopy (n = 9), and both (n = 32), with no findings of bleeding. The most common finding of gastroscopy was atrophic gastritis (36%) while early gastric cancer was detected in 2 patients. The most common finding of colonoscopy was colon polyps (42%) while colorectal cancer was detected in 5 patients. Of 180 FIT-positive patients receiving endoscopy, 8 (4.4%) underwent preoperative GI treatment, while postoperative GI events were documented in 28 (15.6%). Of 1,436 with negative FIT, 21 (1.5%) presented GI complications after surgery.

Conclusion Preoperative FIT, which is influenced by anticoagulant use, has little impacts on identification of GI bleeding sites. However, it may be useful to detect GI malignant lesions, potentially impacting operative risks, surgical strategies, and postoperative management.

Keywords

gastrointestinal bleeding - fecal occult blood - fecal immunochemical test - colorectal cancer


Publication History

Received: 30 November 2022

Accepted: 09 March 2023

Accepted Manuscript online:
13 March 2023

Article published online:
21 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Viana FF, Chen Y, Almeida AA, Baxter HD, Cochrane AD, Smith JA. Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre. ANZ J Surg 2013; 83 (09) 651-656
    CrossrefPubMedSearch in Google Scholar
  • 2 Krawiec F, Maitland A, Duan Q, Faris P, Belletrutti PJ, Kent WDT. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg 2017; 154 (01) 181-188
    CrossrefPubMedSearch in Google Scholar
  • 3 Hess NR, Seese LM, Hong Y. et al. Gastrointestinal complications after cardiac surgery: incidence, predictors, and impact on outcomes. J Card Surg 2021; 36 (03) 894-901
    CrossrefPubMedSearch in Google Scholar
  • 4 Elgharably H, Gamaleldin M, Ayyat KS. et al. Serious gastrointestinal complications after cardiac surgery and associated mortality. Ann Thorac Surg 2021; 112 (04) 1266-1274
    CrossrefPubMedSearch in Google Scholar
  • 5 Loffredo L, Perri L, Violi F. Impact of new oral anticoagulants on gastrointestinal bleeding in atrial fibrillation: a meta-analysis of interventional trials. Dig Liver Dis 2015; 47 (05) 429-431
    CrossrefPubMedSearch in Google Scholar
  • 6 García Rodríguez LA, Martín-Pérez M, Hennekens CH, Rothwell PM, Lanas A. Bleeding risk with long-term low-dose aspirin: a systematic review of observational studies. PLoS One 2016; 11 (08) e0160046
    CrossrefPubMedSearch in Google Scholar
  • 7 Lorusso R, Vizzardi E, Johnson DM. et al. Cardiac surgery in adult patients with remitted or active malignancies: a review of preoperative screening, surgical management and short- and long-term postoperative results. Eur J Cardiothorac Surg 2018; 54 (01) 10-18
    CrossrefPubMedSearch in Google Scholar
  • 8 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedSearch in Google Scholar
  • 9 Imperiale TF, Ransohoff DF, Itzkowitz SH. et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 370 (14) 1287-1297
    CrossrefPubMedSearch in Google Scholar
  • 10 Chiu HM, Jen GH, Wang YW. et al. Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers. Gut 2021; 70 (12) 2321-2329
    CrossrefPubMedSearch in Google Scholar
  • 11 Mankaney G, Sutton RA, Burke CA. Colorectal cancer screening: choosing the right test. Cleve Clin J Med 2019; 86 (06) 385-392
    CrossrefPubMedSearch in Google Scholar
  • 12 Zappa M, Visioli CB, Ciatto S. et al. Gastric cancer after positive screening faecal occult blood testing and negative assessment. Dig Liver Dis 2007; 39 (04) 321-326
    CrossrefPubMedSearch in Google Scholar
  • 13 He E, Alison R, Blanks R. et al. Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England. Int J Epidemiol 2019; 48 (02) 549-558
    CrossrefPubMedSearch in Google Scholar
  • 14 Ng JY, Chan DK, Tan KK. Is gastroscopy for fecal immunochemical test positive patients worthwhile?. Int J Colorectal Dis 2017; 32 (01) 95-98
    CrossrefPubMedSearch in Google Scholar
  • 15 Choi JS, Choi JY, Cho HG. et al. Is esophagogastroduodenoscopy necessary in patients with positive fecal occult blood tests and negative colonoscopy?. Scand J Gastroenterol 2013; 48 (06) 657-662
    CrossrefPubMedSearch in Google Scholar
  • 16 Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ETTL. New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 2013; 145 (01) 105-112.e15
    CrossrefPubMedSearch in Google Scholar
  • 17 Cea Soriano L, Lanas A, Soriano-Gabarró M, García Rodríguez LA. Incidence of upper and lower gastrointestinal bleeding in new users of low-dose aspirin. Clin Gastroenterol Hepatol 2019; 17 (05) 887-895.e6
    CrossrefPubMedSearch in Google Scholar
  • 18 Niikura R, Yamada A, Fujishiro M. et al. The effects of direct oral anticoagulants, warfarin, aspirin and thienopyridine on the performance of immunochemical, faecal, occult blood tests. Digestion 2019; 100 (02) 117-126
    CrossrefPubMedSearch in Google Scholar
  • 19 Robertson DJ, Lee JK, Boland CR. et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US multi-society task force on colorectal cancer. Gastroenterology 2017; 152 (05) 1217-1237.e3
    CrossrefPubMedSearch in Google Scholar
  • 20 Randel KR, Botteri E, Romstad KMK. et al. Effects of oral anticoagulants and aspirin on performance of fecal immunochemical tests in colorectal cancer screening. Gastroenterology 2019; 156 (06) 1642-1649.e1
    CrossrefPubMedSearch in Google Scholar
  • 21 Krishnan S, Eslick GD. Streptococcus bovis infection and colorectal neoplasia: a meta-analysis. Colorectal Dis 2014; 16 (09) 672-680
    CrossrefPubMedSearch in Google Scholar
  • 22 García-Albéniz X, Hsu J, Lipsitch M, Logan RW, Hernández-Díaz S, Hernán MA. Infective endocarditis and cancer in the elderly. Eur J Epidemiol 2016; 31 (01) 41-49
    CrossrefPubMedSearch in Google Scholar
  • 23 Alimi Y, Sosin M, Borsinger TM, Garrett JR, Salameh JR, Espinel CF. Implications of Clostridium septicum in vascular surgery: a case report and outcomes literature review. Ann Vasc Surg 2017; 43 (05) 314.e5-314.e11
    CrossrefPubMedSearch in Google Scholar