title: Outcomes of endoscopy in patients with iron deficiency anemia after Billroth II partial gastrectomy.
abstract: OBJECTIVE
  To determine the frequency of gastrointestinal lesions detected by upper endoscopy and colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery.
  
  
  METHODS
  The authors reviewed the medical records of 116 consecutive patients with a Billroth II partial gastrectomy and 232 age- and gender-matched controls without gastric surgery who were referred for endoscopy to evaluate iron deficiency anemia over a 5-year period.
  
  
  RESULTS
  Clinically important lesions were detected in 22.4% of the patients with gastric surgery and in 59.5% of those with intact stomachs (p < 0.001). In the gastric surgery group, clinically important lesions were found more often in the upper gastrointestinal tract than in the colon (19.0% vs. 3.4%, p < 0.001). In the nonsurgical group, the diagnostic yields of upper endoscopy and colonoscopy were not significantly different (38.4% vs. 32.8%, p = 0.24). Synchronous lesions in the upper and lower gastrointestinal tract were significantly less common in the group of patients with gastric surgery compared with those without gastric surgery (0.0% vs. 11.6%, p < 0.001). Small bowel biopsies and small bowel follow-through did not identify any additional lesions. In the gastric surgery group, multivariate analysis identified abdominal symptoms (OR = 11.2, 95% CI 3.2-39.2, p < 0.001), a positive result on fecal occult blood testing (OR = 6.4, 95% CI 2.0-20.3, p = 0.002), and Billroth II surgery at least 10 years before evaluation (OR = 5.4, 95% CI 1.7-16.7, p = 0.004) as independent predictors of identifying a clinically important lesion by endoscopy.
  
  
  CONCLUSIONS
  Upper endoscopy had a significantly higher diagnostic yield than colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. Prospective studies are necessary to determine the role and cost-effectiveness of colonoscopy in the evaluation of iron deficiency anemia in this patient population.
authors.affiliation: Division of Gastroenterology, VA New York Harbor Healthcare System, Bellevue Hospital, and New York University School of Medicine, New York, New York 10010, USA. Edmund.Bini@med.va.gov
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Bini
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Unger
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Weinshel
mesh_terms: D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood