Who needs an invasive colonoscopy – Pan intestinal capsule endoscopy may have an answer

Aims While bidirectional endoscopy is recognised as the standard approach for the investigation of iron deficiency anaemia (IDA) in male (any age) and non-menstruating female. Often bi-directional endoscopy is booked to investigate this cohort of patient. Aim of this study was to retrospectively evaluate the diagnostic yield (DY) of colonoscopy for potential haemorrhagic lesions in patients undergoing bidirectional endoscopy to investigate anemia.

Methods A retrospective review of all bidirectional endoscopies performed to investigate anaemia between January 2023 to Dec 2023. Basic demographic and endoscopic findings were collected, analysed and interpreted

Results Total of 475 colonoscopies performed with indication of anemia, 424 of 475 (89%) had both OGD and colonoscopy on same day. Mean age 63.97+- 15.4 SD. PHLs were defined as tumour, polyp>20mm, vascular lesions and colitis or ileitis. Overall DY was only 12.5% for PHLs including: colorectal cancer 13 (3%), vascular lesion 10 (2.3%), polyp>=20mm 10 (2.35%), colitis including NSAIDs related colitis 20 (4.7%). As expected112/424 (26%) had positive OGDs. Colonoscopy DY in OGD positive group was 2.6% (3/112) vs 16% (50/312) OR 7, p<0.005. Patients with tumour and significant polyps were older compared to colitis patients (74 yrs vs 54 yrs)

Conclusions Only 12.5% of patients with bidirectional endoscopy had colorectal PHLs and as expected yield was very low (2.6%) in OGD positive cohort. Pan intestinal capsule endoscopy may be more appropriate and cost-effective alternative to invasive colonoscopy after negative OGD as a diagnostic test to investigate anemia. Further proof of concept studies are required to compare DY of PIC vs Colonoscopy in this cohort of patients.

Publication History

Article published online:
27 March 2025