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Abstract
Background Anaemia is common and, in some cases, an indication for an urgent endoscopy via the two-week wait (2WW) pathway. In this retrospective study, we assessed the clinical outcomes of such referrals, describing the types of cancer identified after full investigations in our centre.
Methods Data was collected between December 2021 and December 2022 using the Endoscopy UNISOFT system for all endoscopy procedures prompted by anaemia at Milton Keynes University Hospital. Basic demographics, faecal immunochemical test (FIT), and 2WW referrals from the upper gastrointestinal or colorectal pathway were recorded. Radiological images and multi-disciplinary team outcomes were reviewed.
Results The total number of patients referred to our endoscopy unit was 389. 70% were referred via the colorectal team, while 30% were referred via the UGI pathway.
Data revealed that 33 (8.5%) patients referred with anaemia had cancer (IDDF2024-ABS-0390 Figure 1A. Types of cancer, IDDF2024-ABS-0390 Figure 1B. Types of UGI cancer). Non-GI cancers were 2 lung cancer, 1 renal cancer and 1 tonsillar cancer. 187 patients (48%) had UGI non-cancer pathology e.g. gastritis, duodenitis, peptic ulcer disease, oesophageal varices and coeliac disease. Other pathologies are seen in Figure 1D (IDDF2024-ABS-0390 Figure 1D. Other causes of anaemia).
Out of the 389 patients, 100 patients (25%) had FIT and 37 patients had a positive FIT. Out of the 37 patients with positive FIT, 5 patients (14%) were found to have colorectal cancer (IDDF2024-ABS-0390 Figure 1C. FIT). However, FIT was not performed in the remaining 16 patients with colorectal cancer.
Types of cancer
Types of UGI cance
FIT
Other causes of anaemia
Conclusions The percentage of cancer in our population with anaemia was 8.5%. The main gastrointestinal cancer was colon cancer 5.4% followed by upper gastrointestinal cancer (2.05%) and non-GI cancer (1.02%). The most common cause of anaemia was UGI non-cancer pathology. However, there was no clear aetiology was identified in 23% of our population. There were four non-GI cancers discovered by radiological images/CT scans. Those patients with non-GI cancer were over the age of 60, and while the number is small, radiological imaging remains an important tool for investigating anaemia in the elderly when both OGD and colonoscopy are normal. The FIT test revealed a high false positive rate, with only 14% with positive FIT test having colorectal cancer.