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Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach.
QJM. 2006 Jun; 99(6):389-95.QJM

Abstract

BACKGROUND

British Society of Gastroenterology guidelines recommend that gastrointestinal investigations should be considered in males and post-menopausal women presenting with iron-deficiency anaemia (IDA).

AIM

To compare the diagnostic yields and clinical effectiveness of upper and lower gastrointestinal (GI) investigation in detecting malignancy among patients presenting with IDA.

DESIGN

Retrospective review of case notes, endoscopy records and radiology reports.

METHODS

We reviewed the results of 3798 investigations in 2600 patients presenting to our hospital with IDA from October 1995 to December 2003. The findings of the 2318 gastroscopies were compared with those of the 896 colonoscopies and the 584 barium enemas. Patients diagnosed with GI malignancy were identified and their outcomes determined.

RESULTS

Gastroscopy identified 44 patients with newly-diagnosed upper GI cancer (18 oesophageal, 26 gastric). Thus for patients being gastroscoped for IDA, the Numbers Needed to Investigate (NNI) to detect each cancer was 53. Five-year survival for these 44 patients was 10%, so the NNI to identify each curable upper GI malignancy was 527. Colonoscopy or barium enema identified 111 (7.5%) patients with newly diagnosed colorectal cancer, giving a NNI of 13. Their 5-year survival was 35%, giving a NNI to identify each curable colorectal cancer patient of 38.

DISCUSSION

Potentially curable gastrointestinal malignancy was diagnosed over 13 times more commonly using colonoscopy or barium enema vs. gastroscopy. For patients presenting with IDA, our findings favour investigating the lower GI tract first, or performing both gastroscopy and colonoscopy during the same endoscopy list.

Authors+Show Affiliations

Department of Surgery, Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16682438

Citation

Stephens, M R., et al. "Colonoscopy First for Iron-deficiency Anaemia: a Numbers Needed to Investigate Approach." QJM : Monthly Journal of the Association of Physicians, vol. 99, no. 6, 2006, pp. 389-95.
Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach. QJM. 2006;99(6):389-95.
Stephens, M. R., Hopper, A. N., White, S. R., Jugool, S., Stratford, R., Lewis, W. G., & Allison, M. C. (2006). Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach. QJM : Monthly Journal of the Association of Physicians, 99(6), 389-95.
Stephens MR, et al. Colonoscopy First for Iron-deficiency Anaemia: a Numbers Needed to Investigate Approach. QJM. 2006;99(6):389-95. PubMed PMID: 16682438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach. AU - Stephens,M R, AU - Hopper,A N, AU - White,S R, AU - Jugool,S, AU - Stratford,R, AU - Lewis,W G, AU - Allison,M C, Y1 - 2006/05/08/ PY - 2006/5/10/pubmed PY - 2006/12/9/medline PY - 2006/5/10/entrez SP - 389 EP - 95 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 99 IS - 6 N2 - BACKGROUND: British Society of Gastroenterology guidelines recommend that gastrointestinal investigations should be considered in males and post-menopausal women presenting with iron-deficiency anaemia (IDA). AIM: To compare the diagnostic yields and clinical effectiveness of upper and lower gastrointestinal (GI) investigation in detecting malignancy among patients presenting with IDA. DESIGN: Retrospective review of case notes, endoscopy records and radiology reports. METHODS: We reviewed the results of 3798 investigations in 2600 patients presenting to our hospital with IDA from October 1995 to December 2003. The findings of the 2318 gastroscopies were compared with those of the 896 colonoscopies and the 584 barium enemas. Patients diagnosed with GI malignancy were identified and their outcomes determined. RESULTS: Gastroscopy identified 44 patients with newly-diagnosed upper GI cancer (18 oesophageal, 26 gastric). Thus for patients being gastroscoped for IDA, the Numbers Needed to Investigate (NNI) to detect each cancer was 53. Five-year survival for these 44 patients was 10%, so the NNI to identify each curable upper GI malignancy was 527. Colonoscopy or barium enema identified 111 (7.5%) patients with newly diagnosed colorectal cancer, giving a NNI of 13. Their 5-year survival was 35%, giving a NNI to identify each curable colorectal cancer patient of 38. DISCUSSION: Potentially curable gastrointestinal malignancy was diagnosed over 13 times more commonly using colonoscopy or barium enema vs. gastroscopy. For patients presenting with IDA, our findings favour investigating the lower GI tract first, or performing both gastroscopy and colonoscopy during the same endoscopy list. SN - 1460-2725 UR - https://www.unboundmedicine.com/medline/citation/16682438/Colonoscopy_first_for_iron_deficiency_anaemia:_a_Numbers_Needed_to_Investigate_approach_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hcl053 DB - PRIME DP - Unbound Medicine ER -