*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.
J Clin Gastroenterol. 2014 Feb;48(2):119-26. doi: 10.1097/MCG.0b013e31828f1c8d.
To evaluate gastroenterologists' use of esophagogastroduodenoscopy (EGD) for positive fecal occult blood test (FOBT).
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.
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.
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).
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.
评估胃肠病学家对粪便潜血试验（FOBT）阳性患者行食管胃十二指肠镜检查（EGD）的情况。
结直肠癌筛查时FOBT 阳性时推荐行结肠镜检查。指南建议如果无贫血和胃肠道（GI）症状，则无需进一步检查。
在线调查包括 4 个病例：50 岁及以上的一般风险人群，FOBT 阳性，伴有/不伴有缺铁性贫血和/或上 GI 症状。对于每种情况，调查对象被问及如果结肠镜检查阴性，他们是否仅行结肠镜检查、仅行 EGD、同日行结肠镜和 EGD 检查，或结肠镜检查后不同日再行 EGD 检查。
对 7094 名潜在应答者中的 778 人（11%）进行了调查。在无贫血或上 GI 症状的患者中，65%仅行结肠镜检查；35%加行 EGD（9%同日，25%不同日）。贫血患者中 91%加行 EGD，有症状者中 96%加行 EGD，贫血伴症状者中 100%加行 EGD。在仅 FOBT 阳性（无症状或无贫血）的患者中，多变量分析显示担心诉讼是加行 EGD 检查的主要因素（比值比=4.1；95%置信区间，2.3-7.3）。当计划对 FOBT 阳性行 EGD+结肠镜检查时，与学术机构相比，私人执业与 EGD 在不同日进行相关（比值比=6.3；95%置信区间，2.9-13.5）。
三分之一的胃肠病学家在仅 FOBT 阳性时除结肠镜检查外还会加行 EGD。担心诉讼是决定是否加行 EGD 检查的最重要因素。当计划同时进行两项检查时，与学术机构相比，在私人执业机构中更有可能在不同日进行。
