Related Experiment Video
Updated: Jul 7, 2026
A Novel Approach to Monitoring Graft Neovascularization in the Human Gingiva
Published on: January 12, 2019
Do You Bleed? A 1-Year FOBT Case-Series Study
Spyridon Zouridis1, Daniel Sofia2, Osama Alshakhatreh2
1Division of Gastroenterology and Hepatology, St Louis University, St. Louis, MO.
Insights
Fecal occult blood tests (FOBT) are often misused in hospitals for gastrointestinal bleeding (GIB) investigations. This study found FOBT inefficient for guiding management, leading to unnecessary endoscopies and longer hospital stays.
Area of Science:
- Gastroenterology
- Clinical Diagnostics
- Hospital Medicine
Background:
- Fecal occult blood test (FOBT) is approved for colorectal cancer screening.
- Inappropriate use of FOBT for suspected gastrointestinal bleeding (GIB) in hospitals is common.
- The diagnostic efficiency of FOBT in the inpatient setting for GIB is questionable.
Purpose of the Study:
- To investigate the utilization of FOBT for suspected GIB in a hospital setting.
- To evaluate the impact of FOBT on hospitalization length.
- To assess the effect of FOBT on inpatient endoscopy procedures.
Main Methods:
- Retrospective analysis of 678 FOBT cases over 12 months at a tertiary academic medical center.
- Collected data included FOBT results, hemoglobin levels, rectal examinations, endoscopy performance, hospital stay duration, and gastrointestinal lesion identification.
- Correlation of FOBT results with diagnostic outcomes and patient management.
Main Results:
- Positive FOBT results showed weak test sensitivity, with 13.5% of cases having no endoscopic findings.
- FOBT results poorly guided management; only 14.6% of negative FOBT patients underwent endoscopy, and less than 50% of positive FOBT patients were offered procedural evaluation.
- Patients with positive FOBT experienced longer hospitalizations.
- Endoscopy was performed for GIB investigation in critically anemic patients, irrespective of FOBT results.
Conclusions:
- FOBT is inappropriately utilized for GIB investigation in hospitals.
- Inpatient FOBT use is inefficient, leading to unnecessary endoscopies, prolonged hospital stays, and care delays.
- FOBT should be restricted to outpatient settings and avoided for inpatient GIB and anemia evaluations.
Goals:
The goal of this study is to investigate fecal occult blood test's (FOBT) usage in cases of suspected gastrointestinal bleeding and how it may affect hospitalization length and inpatient endoscopy procedures.
Background:
FOBT is an approved modality used in colorectal cancer screening but is often used inappropriately for the investigation of suspected gastrointestinal bleeding (GIB) in the hospital setting. The efficiency of FOBT when used for this purpose is questionable.
Study:
This study was performed at a 766-bed tertiary academic medical center. All FOBT performed during a 12-month period were identified and 678 cases were analyzed. The results of FOBT were collected along with information regarding patients' hemoglobin levels, rectal examination frequency, performance of endoscopy, length of hospital stay, and presence/absence of gastrointestinal lesions.
Results:
There were no findings on endoscopy in 13.5% of cases with positive FOBT, demonstrating weak test sensitivity. Low percentage (14.6%) of patients having negative FOBT results underwent endoscopy, even with negative FOBT results, whereas less than 50% of positive FOBT patients were offered procedural evaluation, demonstrating the inefficiency of FOBT in guiding management. Patients with positive FOBT had longer hospitalization periods. Even in the absence of GIB symptoms, critically anemic patients would still undergo endoscopy for GIB investigation even without FOBT being performed.
Conclusions:
FOBT is inappropriately used in the hospital setting for GIB investigation. This study shows the inefficiency of FOBT to guide management and the high frequency of positive inpatient FOBT tests leading to unnecessary endoscopic investigation, longer hospitalizations, and delays in care. FOBT should be limited to the outpatient setting and be avoided while investigating GIB, anemia, etc. in the hospital.
