UTILITY OF GASTROSCOPY AT THE TIME OF COLONOSCOPY IN PATIENTS WITH IRON-DEFICIENCY ANEMIA REFERRED TO A COLORECTAL CANCER DETECTION PROGRAM

Aims:

Gastrointestinal lesions are present in 40% of patients with iron deficiency anemia (IDA). The utility of upper endoscopy and its timing are not well defined in guidelines. We aimed to assess the usefulness of a gastroscopy at the moment of colonoscopy in patients with IDA.

Methods:

Retrospective review of patients with IDA referred to our department in a colorectal cancer detection program from January to December 2015.

Results:

We evaluated 97 patients (50.5% men, age 74 ± 12, hemoglobin 104 ± 18 g/L). Colonoscopy alone was performed in 36 (37.1%), gastroscopy alone in 1 (1%), and both in 60 (61.9%). Gastroscopy preceded colonoscopy in 51, and was delayed in 9. The etiology of anemia was diagnosed in 55.7%. Colonoscopy detected lesions in 43 (44.8%) and gastroscopy in 12 (19.7%). Colorectal cancer was detected in 30 (31.3%). Gastric cancer was detected in 4 (6.6%). Gastroscopy was useful in 33.3% of patients without lesions detected by colonoscopy, but only in 7.4% of patients with lesions (p = 0.03). In patients with colorectal cancer gastroscopy was not of use in any case. Biopsies were obtained only in 13 (21.3%) gastroscopies (12 gastric; 4 duodenal). Helicobacter Pylori were detected in 6. No case of celiac disease was diagnosed. Biopsies were taken in 33.3% of the delayed gastroscopies and in 19.2% when performed before colonoscopy (p = 0.34).

Conclusions:

The combination of colonoscopy and gastroscopy was diagnostic in 54,6% of patients with IDA referred to a colorectal cancer detection program. Gastroscopy was not useful in patients diagnosed with colorectal cancer and its usefulness was low if other possible causes of IDA were detected at the time of colonoscopy. A negative colonoscopy for lesions related to IDA could encourage the endoscopist to perform systematic upper biopsies. In consequence, we suggest the colonoscopy should precede the gastroscopy.