title: Enteroscopy for the initial evaluation of iron deficiency.
abstract: BACKGROUND
  Occult gastrointestinal blood loss is generally investigated with colonoscopy and esophagogastroduodenoscopy in patients with iron-deficiency anemia. The aim of this study was to prospectively measure the additional diagnostic yield of examining the jejunum at the time of upper endoscopy in patients with iron-deficiency anemia.
  
  
  METHODS
  Asymptomatic patients with newly diagnosed iron-deficiency anemia who had no identifiable source of blood loss at colonoscopy underwent standard esophagogastroduodenoscopy with the Olympus SIF100L enteroscope followed by overtube-assisted enteroscopy. Upper tract and jejunal sources of blood loss were noted. Biopsy samples from the small bowel were taken when a bleeding lesion was not identified.
  
  
  RESULTS
  Thirty-one consecutive patients (13 men, mean age 71) with no gastrointestinal symptomatology were studied. Eleven patients (35%) had a bleeding source that required only esophagogastroduodenoscopy for identification; 8 patients (26%) had a source only in the jejunum; 2 patients (6%) (one with sprue) had a source in upper tract as well as jejunum. The enteroscopy was rated as causing minimal or mild discomfort in 25 of 31 patients (81%). Using Medicare reimbursement figures, a strategy of performing esophagogastroduodenoscopy first would have cost $656 per patient, whereas the strategy of performing esophagogastroduodenoscopy with enteroscopy as the initial test in all patients costs $467 per patient.
  
  
  CONCLUSIONS
  Performance of push enteroscopy along with esophagogastroduodenoscopy increases the diagnostic yield from 41% to 67% when evaluating the upper gastrointestinal tract of asymptomatic patients with iron-deficiency anemia and, because of a lower cost, should be the preferred initial diagnostic test.
authors.affiliation: Division of Gastroenterology, University Hospitals of Cleveland, Ohio 44106-1736, USA.
authors.forename: A
authors.initials: A
authors.lastname: Chak
authors.forename: G S
authors.initials: GS
authors.lastname: Cooper
authors.forename: M I
authors.initials: MI
authors.lastname: Canto
authors.forename: B J
authors.initials: BJ
authors.lastname: Pollack
authors.forename: M V
authors.initials: MV
authors.lastname: Sivak
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies