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)