Beale, R.; Pinder, R.; Hall, A.; Rogers, M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA34
Academic Journal
Adults with iron deficiency anaemia require Gl tract investigation. Traditionally gastroscopy (FOG) and barium enema (DCBE) are used, with colonoscopy (FOC) if DCBE is normal. Primary FOC is not used because caecal intubation rates may be as Iow as 57% and it is costly. We investigate iron deficiency anaemia with FOG and FOC at one visit. Over 3 years, 64 consecutive patients with iron deficiency anaemia underwent same day FOG and FOC. Preparation was 4 litres kleenprep and fasting from midnight. All received supplemental nasal oxygen monitored by pulse oximetry. All received pharyngeal local anaesthesia and midazolam for FOG, with fentanyl and hyoscine for FOC. No patients required reversal of sedation. There were no perforations or significant haemorrhage. Two patients required admission overnight. In two patients FOG revealed a gastric carcinoma and FOC was omitted. FOC was incomplete in 7 but in 5 of these obstructing pathology prevented completion (true completion 60/62, 97%). Investigation of iron deficiency anaemia by FOG and FOC at one sitting is safe and effective. Significant pathology was found in 17 (27%) patients and 21 (33%) patients were returned to their general practitioner after the examination. This cohort of patients are at high risk of having malignant disease and need expeditious investigation. This approach allows prompt, complete investigation and discharge of many patients directly to primary care with the reassurance that no significant abnormality has been found.


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