Outcomes of endoscopy in patients with iron deficiency anemia after Billroth II partial gastrectomy

J Clin Gastroenterol. 2002 Apr;34(4):421-6. doi: 10.1097/00004836-200204000-00007.


Goals: To determine the frequency of gastrointestinal lesions detected by upper endoscopy and colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery.

Study: 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.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anemia, Iron-Deficiency / diagnosis*
  • Anemia, Iron-Deficiency / etiology
  • Endoscopy, Gastrointestinal*
  • Female
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods
  • Gastrointestinal Diseases / complications
  • Gastrointestinal Diseases / diagnosis*
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Occult Blood