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Enteroscopy for the initial evaluation of iron deficiency
A Chak1, G S Cooper, M I Canto
1Division of Gastroenterology, University Hospitals of Cleveland, Ohio 44106-1736, USA.
Gastrointestinal Endoscopy
|March 25, 1998
Summary
Examining the jejunum during upper endoscopy significantly boosts the detection of gastrointestinal bleeding in iron-deficiency anemia patients. This combined approach is more cost-effective and should be the initial diagnostic strategy.
Area of Science:
- Gastroenterology
- Diagnostic Endoscopy
Background:
- Iron-deficiency anemia often necessitates investigation for occult gastrointestinal blood loss.
- Standard investigations include colonoscopy and esophagogastroduodenoscopy.
Purpose of the Study:
- To prospectively evaluate the added diagnostic value of jejunal examination during upper endoscopy for iron-deficiency anemia patients.
- To compare the cost-effectiveness of this combined approach.
Main Methods:
- Asymptomatic patients with iron-deficiency anemia and negative colonoscopy results underwent esophagogastroduodenoscopy with enteroscopy.
- Both upper tract and jejunal sources of blood loss were identified.
- Biopsies were taken from the small bowel when no bleeding source was found.
Main Results:
- The combined approach identified a bleeding source in 67% of patients, compared to 41% with esophagogastroduodenoscopy alone.
- 8 patients (26%) had a bleeding source exclusively in the jejunum.
- The combined procedure was found to be more cost-effective ($467/patient) than esophagogastroduodenoscopy alone ($656/patient).
Conclusions:
- Push enteroscopy combined with esophagogastroduodenoscopy significantly increases the diagnostic yield for upper gastrointestinal bleeding in asymptomatic iron-deficiency anemia patients.
- This combined strategy should be the preferred initial diagnostic test due to its higher diagnostic yield and lower cost.