Institutional members access full text with Ovid®

Share this article on:

Gastroenterologists’ Practice Patterns for Positive Fecal Occult Blood Test

Kim, John J. MD, MS*; Han, Alexander MD; Yan, Arthur W. MD; Cao, David DO; Laine, Loren MD‡,§

Journal of Clinical Gastroenterology: February 2014 - Volume 48 - Issue 2 - p 119–126
doi: 10.1097/MCG.0b013e31828f1c8d
ALIMENTARY TRACT: Original Articles

Goals: To evaluate gastroenterologists’ use of esophagogastroduodenoscopy (EGD) for positive fecal occult blood test (FOBT).

Background: Colonoscopy is recommended when an FOBT performed for colorectal cancer screening is positive. Guidelines suggest no further evaluation if anemia and gastrointestinal (GI) symptoms are absent.

Methods: Online surveys included 4 vignettes: positive FOBT in average-risk adults 50 years of age or older with/without iron-deficiency anemia and with/without upper GI symptoms. For each scenario, respondents were asked if they would perform colonoscopy only, EGD only, colonoscopy+EGD on same day, or colonoscopy followed by EGD on different day if colonoscopy was negative.

Results: Surveys were returned by 778 (11%) of 7094 potential responders. In patients without anemia or upper GI symptoms, 65% performed colonoscopy only; 35% added EGD (9% same day, 25% different day). EGD was added in 91% with anemia, 96% with symptoms, and 100% with anemia+symptoms. In patients with positive FOBT alone (no symptoms or anemia), multivariate analysis revealed fear of litigation as the primary factor associated with adding EGD to colonoscopy (odds ratio=4.1; 95% confidence interval, 2.3-7.3). When EGD+colonoscopy were planned for positive FOBT, private practice was associated with performing EGD on a different day (odds ratio=6.3; 95% confidence interval, 2.9-13.5 for private versus academic setting).

Conclusions: One third of gastroenterologists perform EGD in addition to colonoscopy for a positive FOBT alone. Fear of litigation is the most important factor in deciding whether to add EGD to colonoscopy. When both procedures are planned, they are more likely to be performed on different days in a private practice setting than in an academic setting.

Supplemental Digital Content is available in the text.

*Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda

Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA

Section of Digestive Diseases, Yale University School of Medicine, New Haven

§VA Connecticut Healthcare System, West Haven, CT

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

The authors declare that they have nothing to disclose.

Reprints: Loren Laine, MD, Section of Digestive Diseases, Yale University School of Medicine, P.O. Box 208019, New Haven, CT 06520-8019 (e-mail:

Received January 2, 2013

Accepted February 25, 2013

© 2014 by Lippincott Williams & Wilkins