title: Gastroenterologists' practice patterns for positive fecal occult blood test.
abstract: OBJECTIVE
  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.
authors: *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.
authors: John J
authors: JJ
authors: Kim
authors: Alexander
authors: A
authors: Han
authors: Arthur W
authors: AW
authors: Yan
authors: David
authors: D
authors: Cao
authors: Loren
authors: L
authors: Laine
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D003113:Colonoscopy; D004415:Dyspepsia / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005762:Gastroenterology; D006356:Heartburn / Q000209:etiology; D006801:Humans; D007325:Institutional Practice; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D009780:Occult Blood; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence; D011331:Private Practice; D011365:Professional Practice Location; D013997:Time Factors