Outcome of endoscopy in patients with iron deficiency anemia and a previous history of partial gastrectomy

Background: Patients with iron deficiency anemia (IDA) and a prior history of partial gastrectomy are frequently referred for a gastrointestinal evaluation, yet the utility of such a workup is unclear. Therefore, we evaluated the diagnostic yield and cost-effectiveness of endoscopy in this patient population. Methods: We reviewed the medical records of consecutive patients with IDA and a prior history of partial gastrectomy who were referred for endoscopy from January 1992 through January 1997. IDA was defined as a hemoglobin < 14 g/dL in males or < 12 g/dL in females with a transferrin saturation < 15% and a ferritin < 20 ug/L. The cost of endoscopy was estimated by adding the physician fee under Medicaid reimbursement, the facility fee, and the pathology fee. Results: 116 patients were evaluated by EGD and colonoscopy. There were 81 males and 35 females with a mean age (±SE) of 61.1 ± 1.0 years (range, 41-88).*P=0.01 compared to patients with no abdominal symptoms and FOBT-. The diagnostic yield of EGD was significantly higher than the yield of colonoscopy (19.0% vs. 3.4%, P = 0.0003). Two patients had more than one lesion detected by EGD and no individual had a lesion identified in both the upper and lower GI tract. All Patients (N=116) Abd Sx's and/or FOBT+ (N=74) No Abd Sx's and FOBT- (N=42) Severe gastritis 9 8 1 Severe esophagitis 5 5 0 Gastric ulcer ≥ 1 cm 4 4 0 Jejunal ulcer ≥ 1 cm 4 2 2 Gastric cancer 2 2 0 Colon cancer 2 1 1 Colon polyps ≥ 1 cm 2 1 1 TOTAL 26 (22.4%) 22 (29.7%) 4 (9.5%) EDG cost/dx $ 3,648.63 $ 2.596.20 $14.173.01 Colonoscopy cust/dx $22,034.56 $27,886.68 $16,182.44 Conclusions: EGD has a significantly higher diagnostic yield and is more cost-effective than colonoscopy in the workup of patients with IDA and a prior history of partial gastrectomy. Our findings would suggest that these patients should initially be evaluated by EGD, especially those individuals in whom abdominal symptoms and/or a positive FOBT are present. Colonoscopy should be reserved for those patients in whom no upper gastrointestinal lesion is detected.