Outcome of imaging investigations in patients with iron deficiency anaemia

Outcome of imaging investigations in

patients with iron deficiency anaemia

Dr Peng Hui LEE (Radiology) Dr Sanjeev KALRA (Medicine)

Mid Essex HospitalsChelmsford, Essex, UK

Introduction

• IDA: GI blood loss most common cause in men and post menopausal women

• No obvious cause: gastro & colonoscopy

• If endoscopy -ve: imaging (?)

Method

• Radiology records of endoscopy patients (9 Aug – 17 Jun 2008)

• If patients had BaFT, US, CT or Ba enema:endoscopy records checked for indications

(Non-university public hospital)

Results

39 patients:Normal gastroscopy and normal/incomplete colonoscopy

•25 Ba FT: all normal•10 Ba En (1 carcinoma)•11 CT (2 positive)• 3 US (normal)

Results

Positive CT:

1.Liver mets + colonic mass incomplete colonoscopy, no Ba enema

2.Lung mets on CXRCT :primary not found

Discussion

Low yield from BaFT

• Rockey (NEJM 1993): • 100 IDA:

38 neg gastro & colonoscopy: 26 enteroclysis, 3 BaFT: all -ve.

• Till  (Gut 1992):• 89 IDA & +ve FOB:

18 BaFT all -ve

Discussion

Video Capsule Endoscopy (VCE)

Better results compared to barium studies

Hara, et al. Imaging of Small Bowel Disease: Comparison of Capsule Endoscopy, Standard Endoscopy, Barium Examination, and CT  RadioGraphics 2005

Discussion

British Society of Gastroenterology (BSG). (2005)

• Transfusion dependent IDA: VCE or enteroscopy may be helpful

• Small bowel radiology rarely useful unless Crohn’s suspected

Discussion

• European Society of GI Endoscopy (2006)

• American Gastroenterological Association (2007)

VCE recommended for obscure GI bleeding: higher yield than radiological tests

Discussion

Good results from enteroclysis in some studies

• Moch, Herlinger, Kochman, Levine, Rubesin, Laufer (AJR 1994): 128 pt GI bleeding: 32 +ve:

19 TP (17 SB tumours, 3 AVM) 5 FP8 stopped bleeding

• Malik (Dig Dis Sci 2005): 67 pt GI bleeding: 27 (21%) +ve

Discussion

• CT enteroclysis

•Jain, et al (Clin Rad 2007): cause of bleeding identified in 1/7 pts

Discussion

• CT enterography

•Huprich (Radiology 2008 Feb):

•64-slice CT•Triple phase (art, enteric, delayed)•20 patients obscure GI bleeding•10 pos CT; 8 pos VCE, 2 neg VCE

Huprich Radiology 2008

The role of imaging in small bowel diseaseA C Planner et al  Imaging (2006) 18, 228-256

Conclusion

IDA ; -ve gastro & colonoscopy:

• Ba FT unhelpful• VCE generally recommended if further

investigation needed• CT enterography/enteroclysis may prove to

be useful• (Some people seem to be very good at

enteroclysis)