Over the years, fecal occult blood testing (FOBT), particularly with guaiac test has seen growth in its application for assessment of symptomatic gastrointestinal disease, without any clear evidence of efficacy. On the contrary, a 2020 meta-analysis, Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications, concluded that “Our results did not show acceptable performance characteristics for FOBT to guide decisions regarding endoscopic evaluation”. This meta-analysis evaluated both guaiac and fecal immunochemical test.
Even though fecal immunochemical test is being trialled very carefully and selectively in parts of the Europe for prioritizing use of endoscopy, in Canada, it is recommended only for colorectal cancer screening among asymptomatic individuals.
Sources:
Ajumobi A, et al. De-implementation of Fecal Occult Blood Testing in the Emergency Department and Hospital Units: A Quality Improvement Project. J Community Hosp Intern Med Perspect. Jan 12 2024;14(1):13-17. PMID: 38482076.
Chan FKL, et al. Joint Asian Pacific Association of Gastroenterology (APAGE)-Asian Pacific Society of Digestive Endoscopy (APSDE) clinical practice guidelines on the use of non-invasive biomarkers for diagnosis of colorectal neoplasia. Gut. Jul 2023;72(7):1240-1254. PMID: 37019620.
Lee MW, et al. Use of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: A Systematic Review and Meta-Analysis. Am J Gastroenterol. May 2020;115(5):662-670. PMID: 31972617.
Sokoro A, et al. Fecal Occult Blood Test for Evaluation of Symptoms or for Diagnostic Testing. Am J Gastroenterol. May 2020;115(5):679-680. PMID: 32058343.