7. Appropriateness of Colonoscopy: Iron-Deficiency Anemia [1]

Introduction

Occult bleeding from the GI tract is a common cause of iron-deficiency anemia in adult men and post-menopausal women. Patients without any obvious blood loss source should be evaluated endoscopically. Cancer of the GI tract, especially of the large bowel, is the most important concern in patients after 50 years of age. This explains why the panel mainly discussed the indication for colonoscopy in the investigation of iron-deficiency anemia, with upper GI endoscopy and even small intestine endoscopy being nevertheless mandatory if the colonoscopy proves to be negative. In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article is divided into three parts: 1. The review of the literature that was used by the panelists as the document to support their ratings of appropriateness of use of UGE in patients with iron-deficiency anemia; 2. An overview of the main panel results; 3. A summary of the published evidence and of the panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

References

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)