Comparison of Diagnostic Yield of Endoscopy in Patients with Chronic Anemia with and Without Iron Deficiency: A Retrospective Study in the United States Veterans Affairs Population

Abstract

Background/Aims: Iron deficiency anemia is a very common reason for referral. There are few recommendations regarding the utility of endoscopy in the mixed anemia and anemia of chronic disease groups. We evaluated the endoscopic diagnostic yield in anemic patients who do not meet criteria for iron deficiency anemia. Methods: We retrospectively reviewed electronic records of 240 patients who underwent endoscopy between January 2010 and December 2013 for anemia (hemoglobin of ≤12.5 gm/dl). We categorized patients into anemia due to iron deficiency, chronic disease and mixed based on transferrin iron saturation and serum ferritin level. Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and video capsule endoscopy were compared. We used severe anemia, requirement of blood transfusion, and use of anticoagulant/antiplatelet agents to examine differences in endoscopic diagnostic yield. Results: There were no differences in diagnostic yield among the three anemia groups, surprisingly, except for a slightly higher yield for esophagogastroduodenoscopy in patients with mixed anemia as compared to iron deficiency anemia (38% vs 23%, p=0.044). Severe anemia slightly increased endoscopic diagnostic yield for esophagogastroduodenoscopy, only in patients with iron deficiency anemia, but not in those with mixed anemia or anemia of chronic disease. Conclusion: Patients with iron deficiency anemia, anemia of chronic disease, and mixed anemia do not differ in endoscopic diagnostic yield. Funding Statement: None. Declaration of Interests: The authors of this research do not have any conflicts of interest to declare. Ethics Approval Statement: The IRB for this study was approved through the Wright State University IRB committee and Dayton Veterans Affairs Medical Center on April 4th, 2016.