Outcome of imaging investigations in patients with iron deficiency anaemia Dr Peng Hui LEE ( Radiology) Dr Sanjeev KALRA ( Medicine) Mid Essex Hospitals Chelmsford, Essex, UK

Introduction IDA: GI blood loss most common cause in men and post menopausal women No obvious cause: gastro & colonoscopy If endoscopy -ve: imaging (?)

IDA: GI blood loss most common cause in men and post menopausal women

No obvious cause: gastro & colonoscopy

If endoscopy -ve: imaging (?)

Method Radiology records of endoscopy patients (9 Aug – 17 Jun 2008) If patients had BaFT, US, CT or Ba enema: endoscopy records checked for indications (Non-university public hospital)

Radiology records of endoscopy patients (9 Aug – 17 Jun 2008)

If patients had BaFT, US, CT or Ba enema: endoscopy records checked for indications

(Non-university public hospital)

Results 39 patients: Normal gastroscopy and normal/incomplete colonoscopy 25 Ba FT: all normal 10 Ba En (1 carcinoma) 11 CT (2 positive) 3 US (normal)

39 patients: Normal gastroscopy and normal/incomplete colonoscopy

25 Ba FT: all normal

10 Ba En (1 carcinoma)

11 CT (2 positive)

3 US (normal)

Results Positive CT: Liver mets + colonic mass incomplete colonoscopy, no Ba enema Lung mets on CXR CT :primary not found

Positive CT:

Liver mets + colonic mass incomplete colonoscopy, no Ba enema

Lung mets on CXR CT :primary not found

Discussion Low yield from BaFT Rockey (NEJM 1993 ): 100 IDA: 38 neg gastro & colonoscopy: 26 enteroclysis, 3 BaFT: all -ve. Till ( Gut 1992 ): 89 IDA & +ve FOB: 18 BaFT all -ve

Low yield from BaFT

Rockey (NEJM 1993 ):

100 IDA: 38 neg gastro & colonoscopy: 26 enteroclysis, 3 BaFT: all -ve.

Till ( Gut 1992 ):

89 IDA & +ve FOB: 18 BaFT all -ve

Discussion Video Capsule Endoscopy (VCE) Better results compared to barium studies Hara, et al . Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT RadioGraphics 2005

Video Capsule Endoscopy (VCE)

Better results compared to barium studies

Hara, et al .

Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT RadioGraphics 2005

Discussion British Society of Gastroenterology (BSG). (2005) Transfusion dependent IDA: VCE or enteroscopy may be helpful Small bowel radiology rarely useful unless Crohn’s suspected

British Society of Gastroenterology (BSG). (2005)

Transfusion dependent IDA: VCE or enteroscopy may be helpful

Small bowel radiology rarely useful unless Crohn’s suspected

Discussion European Society of GI Endoscopy (2006) American Gastroenterological Association (2007) VCE recommended for obscure GI bleeding: higher yield than radiological tests

European Society of GI Endoscopy (2006)

American Gastroenterological Association (2007)

VCE recommended for obscure GI bleeding: higher yield than radiological tests

Discussion Good results from enteroclysis in some studies Moch, Herlinger, Kochman, Levine, Rubesin, Laufer (AJR 1994): 128 pt GI bleeding: 32 +ve: 19 TP (17 SB tumours, 3 AVM) 5 FP 8 stopped bleeding Malik ( Dig Dis Sci 2005): 67 pt GI bleeding: 27 (21%) +ve

Good results from enteroclysis in some studies

Moch, Herlinger, Kochman, Levine, Rubesin, Laufer (AJR 1994): 128 pt GI bleeding: 32 +ve: 19 TP (17 SB tumours, 3 AVM) 5 FP 8 stopped bleeding

Malik ( Dig Dis Sci 2005): 67 pt GI bleeding: 27 (21%) +ve

Discussion CT enteroclysis Jain, et al ( Clin Rad 2007): cause of bleeding identified in 1/7 pts

CT enteroclysis

Jain, et al ( Clin Rad 2007): cause of bleeding identified in 1/7 pts

Discussion CT enterography Huprich ( Radiology 2008 Feb): 64-slice CT Triple phase (art, enteric, delayed) 20 patients obscure GI bleeding 10 pos CT; 8 pos VCE, 2 neg VCE

CT enterography

Huprich ( Radiology 2008 Feb):

64-slice CT

Triple phase (art, enteric, delayed)

20 patients obscure GI bleeding

10 pos CT; 8 pos VCE, 2 neg VCE

Huprich Radiology 2008

The role of imaging in small bowel disease A C Planner et al Imaging (2006) 18, 228-256

Conclusion IDA ; -ve gastro & colonoscopy: Ba FT unhelpful VCE generally recommended if further investigation needed CT enterography/enteroclysis may prove to be useful (Some people seem to be very good at enteroclysis)

IDA ; -ve gastro & colonoscopy:

Ba FT unhelpful

VCE generally recommended if further investigation needed

CT enterography/enteroclysis may prove to be useful

(Some people seem to be very good at enteroclysis)