探查大便潜血试验（FOBT+）受试者上消化道（UGI）的胃镜角色存在争议。我们进行了系统综述和荟萃分析，旨在确定FOBT +受试者中UGI病变的患病率。搜索数据库直到2022年4月，以寻找在行结肠镜和胃镜检查下的FOBT +受试者UGI病变的研究。计算UGI癌症、临床显著病变（CSL，潜在解释隐匿性失血的病变）的汇总患病率、比值比（OR）和95%置信区间（CI）。我们共包括了21项研究，涉及6993名FOBT +受试者。UGI癌症的总体患病率为0.8%（95% CI0.4-1.6），UGI CSL为30.4%（95% CI20.7-42.2），而结肠癌症和CSL的总体患病率分别为3.3% （95% CI1.8-6.0）和31.9%（95% CI23.9-41.1）。在FOBT +受试者中，有结直肠病变/无结直肠病变的UGI CSL和UGI癌症患病率没有显著差异（OR=1.2，95% CI0.9-1.6，P = 0.137，和OR=1.6，95% CI0.5-5.5，P = 0.460，分别）与FOBT +受试者的贫血有关（OR=6.3，95% CI1.3-31.5，P = 0.025），而UGI CSL（OR=4.3，95% CI2.2-8.4，P = 0.0001）没有与胃肠症状有关（OR=1.3，95% CI 0.6-2.8，P = 0.511）。在FOBT +受试者中，UGI癌症和其他CSL的患病率较高。虽然数据表明，在行结肠镜检查的FOBT +受试者中，与单纯的结肠镜检查相比，同日行胃镜检查可发现更多的恶性肿瘤，但有待进一步的前瞻性研究以确定双重内窥镜作为FOBT +所有受试者的标准护理是否具有成本效益。【版权所有©2023美国胃肠内镜学会。由Elsevier Inc.出版。保留所有权利。】

The role of gastroscopy to investigate the upper gastrointestinal (UGI) tract in subjects with positive faecal occult blood test (FOBT+) is controversial. We conducted a systematic review and meta-analysis, which aimed to determine the prevalence of UGI lesions in FOBT+ subjects.Databases were searched until April 2022 for studies reporting UGI lesions in FOBT+ subjects undergoing colonoscopy and gastroscopy. Pooled prevalence rates of UGI cancers and clinically significant lesions ((CSL), lesions potentially explaining occult blood loss)), Odds Ratio (OR) and 95% confidence intervals (CI) were calculated.We included 21 studies, with 6993 FOBT+ subjects. Pooled prevalence of UGI cancers was 0.8% (95%CI0.4-1.6) and UGI CSL was 30.4% (95%CI20.7-42.2), while that of colonic cancers and CSL was 3.3% (95%CI1.8-6.0) and 31.9% (95%CI23.9-41.1), respectively. There was no significant difference in the prevalence of UGI CSL and UGI cancers in FOBT+ subjects with/ without colonic pathology, (OR=1.2, 95%CI0.9-1.6, p=0.137, and OR=1.6, 95%CI0.5-5.5, p=0.460, respectively). Anaemia in FOBT+ subjects was associated with UGI cancers (OR=6.3, 95%CI1.3-31.5, p=0.025) and UGI CSL (OR=4.3, 95%CI2.2-8.4, p=0.0001). Gastrointestinal symptoms were not associated with UGI CSL (OR=1.3, 95%CI 0.6-2.8, p=0.511).In FOBT+ subjects there is an appreciable prevalence of UGI cancers and other CSL. Anaemia but not symptoms or colonic pathology are linked to UGI lesions. While the data suggest that same day gastroscopy in FOBT+ subjects undergoing colonoscopy yields approximately 25% more malignancies as colonoscopy alone, prospective data are required to determine the cost-efficacy of dual-endoscopy as a standard of care for all FOBT+ subjects.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.