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)