Gastroenterologists' practice patterns for positive fecal occult blood test

Area of Science:

• Gastroenterology
• Digestive Endoscopy
• Colorectal Cancer Screening

Background:

• Current guidelines recommend colonoscopy for positive fecal occult blood tests (FOBT) in colorectal cancer screening.
• Further evaluation is typically not advised if anemia and gastrointestinal symptoms are absent.

Purpose of the Study:

• To investigate gastroenterologists' utilization of esophagogastroduodenoscopy (EGD) following a positive fecal occult blood test (FOBT).
• To identify factors influencing the decision to perform EGD in conjunction with colonoscopy for positive FOBT results.

Main Methods:

• Online surveys presented four clinical vignettes of average-risk adults aged 50+ with positive FOBT, varying anemia and upper GI symptom presence.
• Gastroenterologists indicated their planned procedures: colonoscopy only, EGD only, same-day colonoscopy and EGD, or sequential EGD after colonoscopy.

Main Results:

• 35% of gastroenterologists added EGD to colonoscopy for positive FOBT without anemia or symptoms; 65% performed colonoscopy alone.
• EGD was added in 91-100% of cases when anemia or symptoms were present.
• Fear of litigation was the primary driver for adding EGD in asymptomatic/anemia-free patients (OR=4.1).
• Private practice was associated with performing EGD on a different day than colonoscopy (OR=6.3).

Conclusions:

• One-third of gastroenterologists perform EGD in addition to colonoscopy for a positive FOBT, even without concerning symptoms or anemia.
• Fear of litigation significantly influences the decision to perform EGD alongside colonoscopy.
• The setting (private vs. academic) impacts the scheduling of EGD and colonoscopy when both are indicated.