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

This article focuses on evaluating the role of upper gastrointestinal (UGI) endoscopy in addition to colonoscopy for patients with positive Cologuard tests in a rural Appalachian population. The study of 100 average-risk patients found that while only 52% had positive colonoscopy findings, 70% showed significant UGI pathology, such as severe inflammation and ulcers, suggesting that UGI endoscopy may reduce false positives and improve detection of clinically relevant conditions. The findings support incorporating bidirectional endoscopy (both upper and lower) in the diagnostic workup of positive Cologuard tests in certain high-risk populations, particularly those with higher rates of tobacco and alcohol use, to enhance early diagnosis and patient-centered care. Limitations include the single-surgeon setting and small sample size, with further research needed to confirm these results across broader populations.