Introduction
Current guidelines suggest upper and lower GI endoscopy to investigate iron deficiency anaemia (IDA) because of a perceived low risk of small bowel pathology. We aimed to identify the Bleeding Location In The Gastrointestinal Tract (BLITGIT) in patients with IDA.
Aims & Methods
Patients referred to three centres (Sheffield, Hong Kong and Szekesfehervar, Hungary) for the investigation of IDA underwent small bowel (SB) capsule endoscopy (Navicam, AnX Robotica, Plano, US) in the week prior to upper and lower gastrointestinal endoscopy. All lesions were described using terms selected from a predetermined diagnostic list and according to the perceived likelihood of bleeding (P0: unlikely; P1: suspected; P2: likely. Saurin et al., Endoscopy 2003).
Results
Gastroscopy pathology (P1/P2)
| Small bowel pathology (P1/P2)
| Colon pathology (P1/P2)
|
Oesophagitis- 2
Oesophageal ulcer- 1
Oesophageal varices- 2
Gastric erosions- 9
Gastric ulcer- 5
Gastric polyp with blood- 1
Gastric antral vascular ectasia -2
Portal hypertensive gastropathy – 1
Duodenal ulcer- 3
| Angioectasia- 23
Erosion - 18
Ulcers- 16
Polyp with eroded surface- 1
Fresh blood- 3
Portal hypertensive enteropathy- 1
| Haemorrhoids- 15
Colorectal cancer- 3
Ulcerative colitis- 2
Diverticulitis-2
NSAID induced Ulcers- 1
Angioectasia- 2
Radiation proctitis- 2
|
Table-1: Number of patients with P1/P2 pathology identified at gastroscopy, SB capsule and colonoscopy.
92 patients (median age 61 years (IQR 45-72); 54.3% male) had a median haemoglobin of 107.5 g/L (IQR 93.2-121.7), ferritin 8(IQR 8- 18) and iron 3.8(IQR 3.8- 6.4). Completion rates for gastroscopy, colonoscopy and capsule endoscopy were 98.9%, 95.6% and 84.7% respectively. Diagnostic yield of P1/P2 lesions by SB capsule (48.9%) was higher than gastroscopy (27.1%) and colonoscopy (29.3%; p=0.003). On multivariant analysis there was no correlation between age, haemoglobin level, symptoms or medication on pathology. A few patients had more than one P1/P2 lesions. Three patients had colorectal cancer and two patients had a new diagnosis of ulcerative colitis.
Conclusion
The diagnostic yield in the small bowel is higher as compared to the upper and lower GI tract and examination should be considered routinely.