Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Outcome of imaging investigations in patients with iron deficiency anaemia

1,113 views

Published on

A review of anaemic patients referred for imaging following negative upper and lower GI endoscopy showed that barium follow-through was not helpful. Other tests may be more useful.
Presentation at the 6th Balkan Congress of Radiology, 19 Nov 2008, Vrnajcka Banja, Serbia

Published in: Health & Medicine, Education
  • Be the first to comment

  • Be the first to like this

Outcome of imaging investigations in patients with iron deficiency anaemia

  1. 1. 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
  2. 2. Introduction <ul><li>IDA: GI blood loss most common cause in men and post menopausal women </li></ul><ul><li>No obvious cause: gastro & colonoscopy </li></ul><ul><li>If endoscopy -ve: imaging (?) </li></ul>
  3. 3. Method <ul><ul><li>Radiology records of endoscopy patients (9 Aug – 17 Jun 2008) </li></ul></ul><ul><ul><li>If patients had BaFT, US, CT or Ba enema: endoscopy records checked for indications </li></ul></ul><ul><ul><li>(Non-university public hospital) </li></ul></ul>
  4. 4. Results <ul><ul><li>39 patients: Normal gastroscopy and normal/incomplete colonoscopy </li></ul></ul><ul><ul><ul><ul><li>25 Ba FT: all normal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>10 Ba En (1 carcinoma) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>11 CT (2 positive) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3 US (normal) </li></ul></ul></ul></ul>
  5. 5. Results <ul><ul><li>Positive CT: </li></ul></ul><ul><ul><ul><ul><li>Liver mets + colonic mass incomplete colonoscopy, no Ba enema </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lung mets on CXR CT :primary not found </li></ul></ul></ul></ul>
  6. 6. Discussion <ul><ul><li>Low yield from BaFT </li></ul></ul><ul><ul><ul><li>Rockey (NEJM 1993 ): </li></ul></ul></ul><ul><ul><ul><ul><li>100 IDA: 38 neg gastro & colonoscopy: 26 enteroclysis, 3 BaFT: all -ve. </li></ul></ul></ul></ul><ul><ul><ul><li>Till  ( Gut   1992 ): </li></ul></ul></ul><ul><ul><ul><ul><li>89 IDA & +ve FOB: 18 BaFT all -ve </li></ul></ul></ul></ul>
  7. 7. Discussion <ul><ul><li>Video Capsule Endoscopy (VCE) </li></ul></ul><ul><ul><ul><li>Better results compared to barium studies </li></ul></ul></ul><ul><ul><ul><li>Hara, et al . </li></ul></ul></ul><ul><ul><ul><li>Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT  RadioGraphics 2005 </li></ul></ul></ul>
  8. 8. Discussion <ul><ul><li>British Society of Gastroenterology (BSG). (2005) </li></ul></ul><ul><ul><ul><li>Transfusion dependent IDA: VCE or enteroscopy may be helpful </li></ul></ul></ul><ul><ul><ul><li>Small bowel radiology rarely useful unless Crohn’s suspected </li></ul></ul></ul>
  9. 9. Discussion <ul><ul><li>European Society of GI Endoscopy (2006) </li></ul></ul><ul><ul><li>American Gastroenterological Association (2007) </li></ul></ul><ul><ul><li>VCE recommended for obscure GI bleeding: higher yield than radiological tests </li></ul></ul>
  10. 10. Discussion <ul><ul><li>Good results from enteroclysis in some studies </li></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><ul><ul><li>Malik ( Dig Dis Sci 2005): 67 pt GI bleeding: 27 (21%) +ve </li></ul></ul></ul>
  11. 11. Discussion <ul><ul><li>CT enteroclysis </li></ul></ul><ul><ul><ul><ul><li>Jain, et al ( Clin Rad 2007): cause of bleeding identified in 1/7 pts </li></ul></ul></ul></ul>
  12. 12. Discussion <ul><ul><li>CT enterography </li></ul></ul><ul><ul><ul><ul><li>Huprich ( Radiology 2008 Feb): </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>64-slice CT </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Triple phase (art, enteric, delayed) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>20 patients obscure GI bleeding </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>10 pos CT; 8 pos VCE, 2 neg VCE </li></ul></ul></ul></ul></ul>
  13. 13. Huprich Radiology 2008
  14. 14. The role of imaging in small bowel disease A C Planner et al  Imaging  (2006) 18, 228-256
  15. 15. Conclusion <ul><ul><li>IDA ; -ve gastro & colonoscopy: </li></ul></ul><ul><ul><li>Ba FT unhelpful </li></ul></ul><ul><ul><li>VCE generally recommended if further investigation needed </li></ul></ul><ul><ul><li>CT enterography/enteroclysis may prove to be useful </li></ul></ul><ul><ul><li>(Some people seem to be very good at enteroclysis) </li></ul></ul>

×