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Location of gastrointestinal lesions with bleeding potential in patients with iron deficiency anemia: a multicenter

Priya Oka1, Foong W D Tai1, Mohamed G Shiha1

  • 1Academic Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.

Gastrointestinal Endoscopy
|June 30, 2026
PubMed

Insights

Small bowel capsule endoscopy found more bleeding lesions in patients with iron deficiency anemia (IDA) than upper endoscopy or colonoscopy. This highlights the small bowel as a key source for IDA-related bleeding.

Area of Science:

  • Gastroenterology
  • Diagnostic Endoscopy
  • Internal Medicine

Background:

  • Current guidelines recommend esophagogastroduodenoscopy (EGD) and colonoscopy for iron deficiency anemia (IDA) investigation.
  • Small bowel examination is not routinely recommended despite IDA prevalence.
  • Identifying the source of bleeding is crucial for effective IDA management.

Purpose of the Study:

  • To determine the diagnostic yield of small bowel capsule endoscopy compared to EGD and colonoscopy in patients with IDA.
  • To identify the location of potential bleeding lesions causing IDA.
  • To assess the impact of pan-gastrointestinal (GI) endoscopy on patient management.

Main Methods:

  • A prospective, multicenter clinical trial involving 170 patients with IDA.
  • Participants underwent small bowel capsule endoscopy, EGD, and colonoscopy.
  • Lesions were classified by a blinded consensus panel using the Saurin classification (P1/P2 for possible/likely bleeding sources).

Main Results:

  • Small bowel capsule endoscopy identified potential bleeding lesions (P1/P2) in 50% of patients, significantly higher than EGD (28.2%) and colonoscopy (20.0%).
  • The overall diagnostic yield for potential bleeding lesions across the entire GI tract was 71.1%.
  • Management strategies were altered in 52.3% of patients based on the pan-GI endoscopy findings.

Conclusions:

  • Bleeding lesions are more frequently detected in the small bowel than in the upper GI tract or colon in patients with IDA.
  • Small bowel capsule endoscopy offers a higher diagnostic yield for IDA-related bleeding sources.
  • Comprehensive GI evaluation, including the small bowel, is essential for managing IDA.
Abstract

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