3387 Yield of panendoscopy and colonoscopy for iron deficiency in post-gastrectomy patients

• Published in: Gastrointestinal endoscopy 2000-04, Vol.51 (4), p.AB79-AB79
• Main Authors: Hunt, Gordon C., Faigel, Douglas O.
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)14087-8

Intro: Iron (Fe) deficiency is a well documented late complication of partial gastrectomy (PG). The yield of endoscopy in the evaluation of Fe deficient PG patients is unknown. Aim: Determine the utility of panendoscopy (EGD) and colonoscopy (CSP) in Fe deficient patients with prior Billroth I (B-I) or Billroth II (B-II) gastrectomy compared to non-PG patients. Methods: Patients with prior PG who had CSP and/or EGD for evaluation of Fe deficiency were identified and compared to a control (cont) group of Fe deficient patients without history of gastric surgery. The two groups were retrospectively identified using the CORI (Clinical Outcomes Research Initiative) database, between periods of 6/1/96 and 7/31/99 at Oregon Health Sciences University and the Portland VAMC. Patients with a ferritin ≤ 50 μg/L or a transferrin saturation (%sat) ≤ 20% were included and their records reviewed. Patients were excluded for prior gastric surgeries other than a B-I or B-II. Laboratory data included hemoglobin, hematocrit, mean corpuscular volume, ferritin, and %sat. Colonoscopic findings of tumor, polyps ≥1 cm, angiodysplasia >5 in number, active colitis, or colonic ulceration were recorded. The presence of any adenomatous polyp (regardless of size) was also noted. EGD findings evaluated were ulcers, esophagitis, or esophageal/gastric varices (Vxs). Fisher's exact test and Student's T-test were used for statistical analysis. Results: 52 PG patients (35 CSP, 52 EGD) and 53 controls (44 CSP, 53 EGD) were studied. There were 13 BI and 39 BII patients. Mean interval between PG and endoscopy was 22 yr (range 4-46 yr). Demographics and laboratory values were not significantly different between PG and cont groups. Mean ferritin levels were similar (PG=20.6, cont=23.4 μg/L, p=0.3). There were no significant differences (p>0.05) in the proportion of patients with polyps ≥1 cm (PG=9%, cont=7%) or any adenomatous polyps (PG=29% vs 18%). No patient had malignant colonic tumors, active colitis, or significant colonic angiodysplasia. Two patients with PG had colonic ulcers, versus no control patients. Comparing EGD findings, there were no significant differences between groups for the presence of ulcers (PG=14% vs 23%), esophagitis (PG=12% vs 13%), Vxs (PG=4% vs 6%), or presence of any of these three lesions (PG=25% vs 38%). There were no upper GI malignancies. Conclusions: The yield of EGD and CSP is similar in PG and non-PG Fe deficient patients. The endoscopic evaluation of Fe defici