Role of Standard Small Bowel Follow-Through in the Evaluation of Anemia after a Negative Upper and Lower Gastrointestinal Tract Endoscopy

Abstract

Purpose: It has been noted that standard small bowel follow through (SBFT) has become a common investigation in patients with anemia even if the suspicion of small bowel pathology or gastrointestinal (GI) blood loss is low. A review of the literature revealed few studies that looked directly at the utility of SBFT in this population and these studies had a small sample size. Our aim was to evaluate the usefulness of a standard SBFT in detecting significant pathology in asymptomatic patients with anemia and a negative endoscopic evaluation. Methods: We retrospectively reviewed the records of all inpatients referred to the gastroenterology service at Advocate Christ Medical Center, for evaluation of anemia (Hb <13 mg/dl in males and <12 mg/dl in females). Records were reviewed between January 2001 to December 2005. Inclusion criterion: all patients who had esophagogastroduodenoscopy (EGD) and colonoscopy for anemia followed by a standard SBFT. Exclusion criterion: patients with overt GI signs or symptoms (e.g. nausea, vomiting, abdominal distention, abdominal pain, early satiety or active GI bleeding), a history of, or a current GI malignancy, cirrhosis, inflammatory bowel disease, and those patients who were found to have an obvious source of anemia on endoscopic examination. Results: A total of 415 patients were referred to the gastroenterology service. 202 patients (69 men, 133 female) met the study criterion. Only 8 patients (3.9%) were found to have an abnormal SBFT. 194 patients (96.1%) had a negative study. The abnormal findings included diverticular disease in 6 patients, duodenitis in 1 patient and possible small bowel polyposis in 1 patient. Only the finding of possible small bowel polyposis was thought to be the cause of anemia by the attending gastroenterologist. In summary standard SBFT identified the possible cause of anemia in only 1/202 patients (0.5%). Conclusions: SBFT was not found to be useful in detecting a cause of anemia in asymptomatic patients with a prior negative upper and lower endoscopic evaluation. Consideration should be made to remove the standard SBFT as a part of the routine work up for patients in this population.