SAME SESSION BI-DIRECTIONAL ENDOSCOPY – TIME FOR A TAILORED APPROACH

Aims:

In the United Kingdom (UK), patients with iron deficiency anaemia (IDA) are referred to secondary care for investigations. The British Society of Gastroenterology (BSG) recommends urgent upper gastrointestinal (UGI) and lower gastrointestinal (LGI) endoscopies for patients with IDA. This is the commonest indication for simultaneous bi-directional endoscopy. The aim of this study was to determine the utility of bi-directional endoscopy in patients with IDA.

Methods:

All patients who had simultaneous bidirectional endoscopies between July 2015 and December 2016 at a UK Trust were recruited into the study. Demographic and clinical data which included endoscopic findings and histology were analysed using SPSS.

Results:

1650 patients (male n = 785, female n = 870, age 63 (16 – 95)) underwent both procedures simultaneously in the study period. 972 patients were anaemic (male = 538, female = 434), 798 had IDA (male = 402, female = 396). The majority of patients had normal findings on endoscopy (80% UGI, 77% of LGI. Neoplastic lesions were found in only 0.9% (n = 15) on UGI endoscopy but in 4% (n = 61) on LGI endoscopy. A further 0.3% (n = 5 UGI) and 14% (n = 230 LGI) had polyps with malignant potential. In all anaemic patients, overall malignancy detection rate was 3.5% (n = 58) (UGI n = 9 vs. LGI n = 49, p < 0.05). Specifically, in patients with IDA, an overall malignancy detection rate for both UGI and LGI endoscopies was 3% (n = 49) (UGI n = 5 vs. LGI n = 44, p < 0.05).

Conclusions:

This study suggests that urgent UGI endoscopies may be unnecessarily performed in patients with anaemia. The national use of faecal immunochemical testing may reduce the number of colonoscopies and allow for more strategic use of LGI endoscopies in the investigations of anaemia. It seems prudent that the recommendation for urgent endoscopic investigation for anaemia be revisited.