2010 The scope of CT in investigating iron deficiency anaemia in the context of frailty

Iron Deficiency Anaemia (IDA) is a highly prevalent co-morbidity in older patients with advanced frailty. It’s associated with adverse outcomes and heightened all-cause mortality. IDA is frequently multifactorial and can stem from various gastrointestinal causes. The British Society of Gastroenterology and National Institute for Health and Care Excellence advocate a combination of endoscopy and computerised tomography (CT) as the gold standard investigations for IDA. The aim of this review was to evaluate oesophagogastroduodenoscopy (OGD) findings and management outcomes of clinically frail patients with IDA.

We review notes for patients referred for OGD to investigate IDA without additional symptoms over a six-month period. The inclusion criteria were IDA, age of 65 years or greater and a clinical frailty score of 5 or greater.

53 patients met the inclusion criteria. A single case (1.8%) UGI malignancy using OGD was identified prior to CT. Thus, demonstrating low yield of OGD in malignancy. 35.6% of patients underwent CT scanning 3 months prior to OGD. Approximately 90% of OGD findings were benign. 23% of patients died within 90 days of OGD. No significant adverse events during OGD or significant complications were recorded in our cohort. It is therefore highly unlikely that the undergoing of an OGD had a direct impact on mortality.

This review shows there is a low yield of UGI malignancy on OGD following a negative CT. Benign upper GI condition is the most common finding. Thus, CT imaging alone may be an adequate investigation to rule out UGI malignancy in this group. Considering there is a high mortality rate in older patients with frailty, following an OGD, we suggest considering starting empirical treatment with PPI and iron replacement as a suitable and less invasive alternative to OGD after a negative CT in frail patients.