Introduction Recent British Society of Gastroenterology (BSG) guidelines1 recommend all post-menopausal women and all men with confirmed iron deficiency anaemia (IDA) should be considered for upper and lower gastrointestinal investigation. Increasing demands on limited resources mean a straight-to-test approach is commonly adopted in busy gastrointestinal units. In the elderly this may result in poor attendance and inappropriate endoscopic investigations in high-risk patients.
Methods We looked at one year's experience of a nurse-led one-stop IDA service which offered an initial clinic visit to discuss the most appropriate mode of investigation in patients aged 75 years and older. Four options were considered: bi-directional endoscopy, OGD and CT colonography with faecal tagging, plain CT scan of abdomen/pelvis or treatment of anaemia without investigation. Data were collected retrospectively for the period of April 2010 to April 2011 for this group of patients.
Results 244 patients were referred over the year. Ninety-six were 75 and over: 67 female, 30 male. Age range of 75–97. Fifty-nine patients had confirmed IDA based on the haemoglobin level, mean corpuscular volume (MCV) and ferritin. Twenty-seven patients were iron deficient without anaemia. Ten patients had normocytic anaemia. In the IDA group: 25/59 (42.3%) patients qualified for bi-directional endoscopy. 16/59 (27%) patients opted for alternative investigations and 18/59 (30.5%) either were not suitable, chose not to be investigated or did not attend their appointments. In the iron-deficient group: 6/27 (22%) underwent bi-directional endoscopy. 7/27 (26%) had alternative investigations and 14/27 (51.8%) were not investigated for reasons as outlined in the IDA group. In the normocytic anaemia group: 4/10 (40%) had IDA, 1/10 (10%) underwent bi-directional endoscopy. Only 32/96 (33%) patients initially referred to the IDA service underwent bi-directional endoscopy.
Conclusion Only a third of elderly patients referred for investigation of IDA were appropriate for bi-directional endoscopy. A straight-to-test approach in this group of patients is likely to result in inefficiencies in endoscopy slots and inappropriate investigations in a high-risk group. We recommend a one-stop initial clinic assessment in this group of patients.
Competing interests None declared.
Reference 1. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut 2011;60:1309–16.
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