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Barium enema or colonoscopy for the investigation of iron deficiency anaemia?
J M Sayer1, M T Donnelly, A S McIntyre
1City Hospital, Nottingham.
Objective:
To determine whether double contrast barium enema is adequate for excluding carcinoma of the colon in patients with iron deficiency anaemia.
Design:
Prospective audit.
Subjects:
One hundred and twenty-three patients with iron deficiency anaemia.
Intervention:
All patients had upper intestinal (GI) endoscopy, duodenal biopsy and double contrast barium enema. Malignant disease and other GI pathology were treated. Patients with recurrent or persistent anaemia at follow-up were colonoscoped.
Outcome Measure:
Colon cancer missed on barium enema examination but detected on colonoscopic examination.
Results:
An identified GI lesion contributing to their anaemia and 11 colon cancers were found in 71% of patients, all identified on barium enema. Two pre-cancerous conditions were missed on barium enema examination. Only 45% colonoscopies inspected the caecum.
Conclusion:
Double contrast barium enema with sigmoidoscopy is probably sufficient for excluding carcinoma of the colon in iron deficiency anaemia.