Introduction Direct access endoscopy can provide a timely and efficient service. Since 2011 we have provided a direct access bidirectional endoscopy (BDE) service for iron deficiency anaemia (IDA) in our local catchment area. Inclusion criteria are age 50–79 years (and postmenopausal if female), ferritin ≤20 ng/ml, haemoglobin ≤13 g/dl for men and ≤11 g/dl for women. Exclusion criteria are too frail for full bowel prep or colonoscopy, IDA previously investigated, known active inflammatory bowel disease, known coeliac disease or positive tissue transglutaminase antibody result. Haemoglobin and ferritin results are checked before accepting the referral and BDE is performed within 2 weeks.
Method To analyse the uptake and effectiveness of our local direct access BDE pathway for IDA.
All patients having same day BDE for the indication of anaemia were retrospectively identified using the endoscopy database over a 3 month period. Prior haemoglobin and ferritin were documented and clinic follow ups identified via an electronic patient record database.
Results 51 patients were identified as having BDE for anaemia over the study period. 27 had BDE via the open access pathway, age range 55–79, haemoglobin range 67–122 g/dl for men, haemoglobin range 64–110 g/dl for women and ferritin range was 3–22 ng/ml. All had distal duodenal biopsies performed. Only three of these 27 patients were subsequently seen in the local gastroenterology clinics over a one year follow up period; one had coeliac disease, one had ulcerative colitis and one had cancer. One patient had a repeat gastroscopy to check for ulcer healing.
There were 24 patients that had BDE via secondary care referral and five were >80 years and three were <50 years of age. Of the 16 secondary care referrals aged 50–79 years, ten did not fulfil the haemoglobin and/or ferritin criteria of the direct access BDE pathway. Only two of the remaining six patients did not have an obvious reason why they had not been referred via the direct access BDE pathway for IDA.
Conclusion Our mature direct access BDE service for IDA is highly utilised by primary care practitioners with over 90% of patients fulfilling the inclusion criteria (and without complicating factors) being referred via this pathway. Only 3 of the 27 patients having direct access BDE for IDA were subsequently seen in the local gastroenterology clinics over a one year follow up period. The results demonstrate a timely and efficient direct access BDE service for IDA.
Disclosure of Interest None Declared
- direct access
- IRON Deficiency