Barium enema or colonoscopy for the investigation of iron deficiency anaemia?

OBJECTIVE

To determine whether double contrast barium enema is adequate for excluding carcinoma of the colon in patients with iron deficiency anaemia.

DESIGN

Prospective audit.

SUBJECTS: One hundred and twenty-three patients with iron deficiency anaemia.

INTERVENTION: All patients had upper intestinal (GI) endoscopy, duodenal biopsy and double contrast barium enema. Malignant disease and other GI pathology were treated. Patients with recurrent or persistent anaemia at follow-up were colonoscoped.

OUTCOME MEASURE: Colon cancer missed on barium enema examination but detected on colonoscopic examination.

RESULTS

An identified GI lesion contributing to their anaemia and 11 colon cancers were found in 71% of patients, all identified on barium enema. Two pre-cancerous conditions were missed on barium enema examination. Only 45% colonoscopies inspected the caecum.

CONCLUSION

Double contrast barium enema with sigmoidoscopy is probably sufficient for excluding carcinoma of the colon in iron deficiency anaemia.