Diagnostic Yield of Endoscopy in Patients with Chronic Anemia Without Classic Iron Deficiency: A Retrospective Study in the U.S. Veterans Population
Year: 2018
Type: article
Study design: Observational Study
Abstract: Introduction: In the developed world, iron deficiency anemia (IDA) occurs in 2 to 5% of adult men and postmenopausal women and is a common reason for gastroenterology referrals. Patients undergoing investigation may instead have anemia of chronic disease (ACD) or have mixed anemia (MA). While IDA is an established indication for endoscopic investigation, there are few recommendations regarding the utility of endoscopy in the MA and ACD groups. In this retrospective study, we evaluated the endoscopic diagnostic yield (EDY) in anemic patients who do not meet criteria for IDA. Methods: We retrospectively reviewed electronic medical records of 240 patients in the Veterans Affairs population who underwent endoscopy between January 2010 and December 2013 for anemia, which was defined as hemoglobin (Hgb) of ≤12.5 gm/dl. We categorized patients into IDA, ACD and MA based on transferrin iron saturation and serum ferritin level. We then compared the EDY of esophagogastroduodenoscopy (EGD), colonoscopy (CSP), and video capsule endoscopy (VCE) among the three groups of anemia. We used severe anemia (defined as Hgb of ≤7 gm/dl), requirement of blood transfusion, and use of anticoagulant/antiplatelet agents to examine differences in EDY within each of the three groups of anemia. Results: There were no differences in EDY among the three anemia groups, except for, surprisingly, a slightly higher yield for EGD in patients with MA as compared to IDA (38% vs 23%, p=0.044). Requirement for blood transfusion and use of anticoagulant-antiplatelet agents did not lead to increased EDY within each of the three groups. Only severe anemia (Hgb ≤7gm/dl), slightly increased EDY for EGD in patients with IDA, but not in those with MA or ACD. Conclusion: In our sample of 240 patients, EGD was performed in 90% of patients, CSP in 78% and VCE in 13% of patients. While we anticipated that IDA would have a higher diagnostic yield than MA or ACD, our study did not find this to be the case for any of the three procedures. Our findings suggest that endoscopy may be beneficial even in patients without classic iron deficiency anemia. In the absence of formal guidelines, future prospective studies are suggested for the use of endoscopy in patients with chronic anemia and absence of classic iron deficiency. This should account for the limitations that were noted in our study.487_A Figure 1. Baseline Demographic, Laboratory and Clinical Characteristics.487_B Figure 2. Pairwise comparison of diagnostic yield: IDA, mixed anemia, and ACD487_C Figure 3. Comparison of endoscopic yield based on requirement of blood transfusion, use of anti-platelet or anti-thrombotic agent, and severe anemia.
Institution: Wright State University
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2922225745