Investigation Of Gastrointestinal Tract Research Articles

OC-021 Should the Renal Tract be Routinely Investigated in Iron Deficiency Anaemia?

Introduction Iron deficiency anaemia (IDA) accounts for 4–13% of referrals to gastroenterology. The British Society of Gastronterology IDA guidelines recommend the investigation of the gastrointestinal (GI) tract, but not the renal tract. A single consultant led one stop IDA clinic was set up. As part of the evaluation of IDA, urine microscopy and an ultrasound or CT abdomen/pelvis (if used in lower GI tract examination) were performed to investigate for renal tract malignancies, alongside GI tract investigations. We aimed to demonstrate the yield of renal and GI tract malignancies in patients with IDA. Methods Patients with IDA or isolated hypoferritinaemia attending the clinic from 2013–2015 who underwent urine microscopy and an ultrasound or CT abdomen/pelvis alongside bidirectional GI investigations (Upper GI: gastroscopy/barium swallow/CT; lower GI: colonoscopy/barium enema/CT) were analysed. We described the yield of haematuria from urine microscopy and the yield of malignancy from renal and GI tract investigations. Results A total of 196 patients had renal tract investigations alongside bidirectional GI investigations (152 urinalysis/ultrasound, 44 urinalysis/CT). 6.1% (12/196) patients had microscopic haematuria. Four renal tract cancers were found: 2 from the haematuria group and 2 from the normal urine microscopy group. In the haematuria group, 2 bladder cancers were identified by CT and cystoscopy respectively. The latter patient was asymptomatic apart from gastroesophageal reflux and had no weight loss. He had a normal gastroscopy, colonoscopy and ultrasound abdomen. A cystoscopy was performed due to the persistent haematuria, which revealed a bladder cancer. In the normal urinalysis group, CT identified 1 prostate cancer and 1 renal cell carcinoma (RCC) where both patients presented with weight loss. The yield of renal tract malignancies in this cohort was 2.0% (4/196). The yield of GI malignancy was 3.1% (6/196) from bidirectional GI investigations in the same cohort of patients. All GI malignancies identified were colorectal cancers. Conclusion The ratio of renal: GI tract malignancies was 2:3 in this cohort. Urine microscopy identified 50% of renal tract cancers. Following the standard practice of bidirectional GI investigations for IDA, the 1 case of asymptomatic bladder cancer would have been missed had urine microscopy not been performed. Routine urine microscopy is easy and cheap to perform, and should be tested in all patients with IDA, and those with haematuria should have their renal tracts investigated. Routine renal tract ultrasound in the asymptomatic IDA patient is not indicated. Disclosure of Interest None Declared

Incidental gastrointestinal 18F-Fluorodeoxyglucose uptake associated with lung cancer.

BackgroundF-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is increasingly used for the initial staging and restaging of lung cancer. Incidental gastrointestinal findings are often observed on 18F-FDG PET/CT. The objective of this study was to assess incidental 18F-FDG uptake by the gastrointestinal tract (GIT) in patients with lung cancer.MethodsTwo hundred thirty consecutive 18F-FDG PET/CT examinations performed for lung cancer over a 3-year period were retrospectively reviewed for the presence of incidental FDG uptake in the GIT. The charts of patients with positive FDG uptake were then reviewed and analysed to determine the GIT uptake sites, the standardized uptake value (SUV) max and the final clinical diagnosis.ResultsFifty-two patients (52/230, 23 %) demonstrated incidental FDG uptake in the GIT. Thirty-three patients (63.5 %) had diffuse uptake (oesophagus, n = 2, colon, n = 31) and 19 patients (36.5 %) had focal uptake (oesophagus, n = 1, small bowel, n = 1, ascending colon, n = 5, descending colon, n = 4, sigmoid, n = 4, rectum, n = 3, and anal margin, n = 1). Twelve of the 52 patients with GIT uptake were further investigated, revealing, a diagnosis of malignancy in 4 patients with focal FDG uptake. No significant differences in mean SUVmax were observed between patients with malignant and benign GIT diseases.ConclusionThis study demonstrates a high incidence of FDG uptake in the GIT associated with lung cancer. Focal GIT uptake was frequently associated with malignant disease. These results suggest that further GIT investigations should be performed in patients with focal GIT uptake.

Gastrointestinal Endoscopy In The Cat

Feline gastrointestinal (GI) endoscopy is in high demand, particularly by cat owners already aware of the clinical benefits and availability of this procedure within the human healthcare system. This article will provide a basic introduction to GI flexible endoscopy, covering important aspects of endoscope selection, clinical indications, and basic techniques required to perform a thorough and diagnostically meaningful examination in the cat. Challenges associated with implementing endoscopy in GI tract investigations can include lack of appropriate/suitable-sized equipment to perform a thorough examination in the cat, insufficient operator training/understanding in how to 'drive the scope' through the GI tract, and/or lack of confidence in differentiating normal from abnormal. This article is intended to familiarize and motivate the feline practitioner to develop basic endoscopic skills. Clinical proficiency can only be obtained through use of appropriate equipment, formal training and hours of practice indistinguishing normal from abnormal. The guidance contained in this article is based on a combination of the published literature, the authors' personal experience and the experience of colleagues.