Table 1

Guidelines for colonoscopy work-up with presentation of iron-deficiency anaemia (IDA) or haematochezia

Symptomatic presentationOrganisationRecommendations
Iron Deficiency AnaemiaAmerican Gastroenterological Association25 Bidirectional endoscopy (esophagogastroduodenoscopy and colonoscopy) in asymptomatic postmenopausal women and all men with IDA.
Bidirectional endoscopy in asymptomatic premenopausal women with IDA
American Society of Gastrointestinal Endoscopy13 Colonoscopy regardless of age or sex
British Society of Gastroenterology14 Upper and lower gastrointestinal investigations in postmenopausal women and all men with IDA, unless there is a history of significant non-GI blood loss.
European Panel on the Appropriateness of Gastrointestinal Endoscopy15 Colonoscopy indicated for:
Patients ages≥50 
Men ages<50 with lower abdominal symptoms (eg, abdominal pain, change in bowel habits).
Women without gynaecological symptoms and presenting with lower abdominal symptoms.
Men and women ages<50 without lower abdominal symptoms but no known source of bleeding identified.
HematocheziaAmerican Society of Gastrointestinal Endoscopy16 Digital rectal exam and flexible sigmoidoscopy with or without anoscopy prior to colonoscopy among healthy individuals ages≤40 years
European Panel on the Appropriateness of Gastrointestinal Endoscopy15 Colonoscopy indicated for:
Adults ages≥50
Adults ages<50 without bright red blood, without source of bleeding identified at sigmoidoscopy or anoscopy, or in the presence of any CRC risk factors such as personal or family history of CRC or inflammatory bowel disease.
  • CRC, colorectal cancer; IDA, iron deficiency anaemia.