Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia

Br J Surg. 1997 Dec;84(12):1725-8.


Background: The investigation of iron-deficiency anaemia is often inadequate. Synchronous upper and lower gastrointestinal endoscopy under the same sedative episode (bidirectional endoscopy; BDE) has been proposed for all such patients.

Methods: The value of this strategy has been examined prospectively. Eighty-nine patients with iron-deficiency anaemia underwent BDE using local anaesthesia of the throat and intravenous midazolam.

Results: A cause for gastrointestinal blood loss was found in 75 patients (84 per cent) after BDE alone. Twenty-five patients (28 per cent) had upper gastrointestinal pathology alone, 24 (27 per cent) had lower gastrointestinal pathology alone and 26 (29 per cent) had dual pathology. Forty-five patients (51 per cent) had gastrointestinal malignancy. Twenty patients (22 per cent) had further investigations and these yielded a diagnosis in five. No cause for the anaemia was found in nine patients (10 per cent). Treatment of the bleeding source(s) resolved the anaemia in all but one patient.

Conclusion: BDE is an effective investigation for patients with iron-deficiency anaemia and its use should be encouraged.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia, Iron-Deficiency / etiology*
  • Endoscopy, Gastrointestinal / methods
  • Female
  • Gastrointestinal Diseases / complications
  • Gastrointestinal Diseases / diagnosis*
  • Gastrointestinal Diseases / therapy
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Male
  • Middle Aged
  • Recurrence