Introduction The BSG guidelines for iron deficiency anaemia (IDA) advise investigation with bi-directional endoscopy, with imaging of the small bowel reserved for patients failing to respond to iron or patients with a recurrence of anaemia within 2 years and failing to respond to iron. There is no guidance on when repeat endoscopic investigation should be considered.
Method We searched our endoscopic database for patients who had undergone repeat bi-directional endoscopy for the indication ‘anaemia’ over the last 12 years (2005–2016). Diagnoses at index and repeat endoscopies were compared. Significant findings accountable for recurrent anaemia were classified as: carcinoma; polyp >1.5 cm; ulcer >1 cm; angiodysplasia >5/requiring APC; severe oesophagitis (LA grade C/D); coeliac disease.
Results 232 patients (median age 66 [range 38–84]; 120 female) were identified. Findings responsible for anaemia at index investigation were noted in 16 (6.9%) patients at gastroscopy and 24 (10.3%) patients at colonoscopy (see Table 1). Repeat investigations were performed at a median of 41 months (range 3–106). Findings accounting for anaemia on repeat investigation were detected in 12 (5.2%) patients at gastroscopy (1 angiodysplasia was also present at index) and 10 (4.3%) patients at colonoscopy (3 out of 4 with angiodysplasia were present at index; 1 was a recurrence of malignancy). Thus, new findings occurred in 11 (4.7%) patients at gastroscopy, and 7 (3.0%) patients at colonoscopy. Three gastric carcinomas arose 19, 20 and 52 months after initial gastroscopy (one was a GOJ carcinoma arising in an index case of Barrett’s oesophagus). The 2 colorectal carcinomas occurred 20 and 41 months (the former a recurrence) after index colonoscopy (bowel preparation was adequate in both initial colonoscopies).
Conclusion The findings suggest a small but significant yield from repeat bi-directional endoscopy in recurrent anaemia, with malignancy being identified in 1.3% at repeat gastroscopy and 0.9% at repeat colonoscopy.
Reference1. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anaemia. Gut2011;60:1309–16.
Disclosure of Interest None Declared
- iron deficiency anaemia