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Outcome of imaging investigations in patients with iron deficiency anaemia


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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
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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>