Enteroscopy for the initial evaluation of iron deficiency

A. Chak, G. S. Cooper, Marcia Canto, B. J. Pollack, Jr Sivak M.V.

Research output: Contribution to journalArticle

Abstract

Background: Occult gastrointestinal blood loss is generally investigated with colonoscopy and esophagogastroduodenoscopy in patients with iron- deficiency anemia. The aim of this study was to prospectively measure the additional diagnostic yield of examining the jejunum at the time of upper endoscopy in patients with iron-deficiency anemia. Methods: Asymptomatic patients with newly diagnosed iron-deficiency anemia who had no identifiable source of blood loss at colonoscopy underwent standard esophagogastroduodenoscopy with the Olympus SIF100L enteroscope followed by overtube-assisted enteroscopy. Upper tract and jejunal sources of blood loss were noted. Biopsy samples from the small bowel were taken when a bleeding lesion was not identified. Results: Thirty-one consecutive patients (13 men, mean age 71) with no gastrointestinal symptomatology were studied. Eleven patients (35%) had a bleeding source that required only esophagogastroduodenoscopy for identification; 8 patients (26%) had a source only in the jejunum; 2 patients (6%) (one with sprue) had a source in upper tract as well as jejunum. The enteroscopy was rated as causing minimal or mild discomfort in 25 of 31 patients (81%). Using Medicare reimbursement figures, a strategy of performing esophagogastroduodenoscopy first would have cost $656 per patient, whereas the strategy of performing esophagogastroduodenoscopy with enteroscopy as the initial test in all patients costs $467 per patient. Conclusions: Performance of push enteroscopy along with esophagogastroduodenoscopy increases the diagnostic yield from 41% to 67% when evaluating the upper gastrointestinal tract of asymptomatic patients with iron-deficiency anemia and, because of a lower cost, should be the preferred initial diagnostic test.

Original languageEnglish (US)
Pages (from-to)144-148
Number of pages5
JournalGastrointestinal Endoscopy
Volume47
Issue number2
DOIs
StatePublished - 1998
Externally publishedYes

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Iron
Digestive System Endoscopy
Iron-Deficiency Anemias
Jejunum
Colonoscopy
Costs and Cost Analysis
Hemorrhage
Occult Blood
Upper Gastrointestinal Tract
Celiac Disease
Medicare
Routine Diagnostic Tests
Endoscopy
Biopsy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Enteroscopy for the initial evaluation of iron deficiency. / Chak, A.; Cooper, G. S.; Canto, Marcia; Pollack, B. J.; Sivak M.V., Jr.

In: Gastrointestinal Endoscopy, Vol. 47, No. 2, 1998, p. 144-148.

Research output: Contribution to journalArticle

Chak, A. ; Cooper, G. S. ; Canto, Marcia ; Pollack, B. J. ; Sivak M.V., Jr. / Enteroscopy for the initial evaluation of iron deficiency. In: Gastrointestinal Endoscopy. 1998 ; Vol. 47, No. 2. pp. 144-148.
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