Location of gastrointestinal lesions with bleeding potential in patients with iron deficiency anemia: a multicenter prospective study.

BACKGROUND AND AIMS: Guidelines recommend EGD and colonoscopy to investigate iron deficiency anemia (IDA), but not small-bowel examination. The aim of the study was to determine the diagnostic yield and location of lesions causing IDA by performing a pan-enteric examination.

METHODS

In a prospective, multicenter clinical trial involving 2 public hospitals (United Kingdom and Hong Kong) and a private health center (Hungary), patients underwent small-bowel capsule endoscopy, EGD, and colonoscopy. All lesions identified were described by a blinded consensus panel using a diagnostic register and the Saurin classification (P1 and P2: possible and likely causes of bleeding, respectively).

RESULTS

In 170 patients (median, 60.0 years; 47.6% female), small-bowel capsule endoscopy identified P1 or P2 lesions in 85 patients (50.0%; 95% CI, 42.2-57.7), EGD identified in 48 patients (28.2%; 95% CI, 21.6-35.6), and colonoscopy identified in 34 patients (20.0%; 95% CI, 14.2-26.8). The yield of capsule endoscopy for P1 or P2 lesions was higher than EGD (P < .001) and colonoscopy (P < .0001). P2 lesions alone were identified in 17 (10.0%; 95% CI, 6.0-15.5), 11 (6.5%; 95% CI, 3.3-11.3), and 16 (9.4%; 95% CI, 5.4-14.8) patients, respectively. Pan-GI endoscopy identified potential bleeding lesions in 121 patients (71.1%; 95% CI, 64.4-77.9), which changed management in 89 patients (52.3%; 95% CI, 44.5-60.0).

CONCLUSIONS

Over two-thirds of patients with IDA had lesions with bleeding potential and they were more common in the small bowel than the upper GI tract and colon.