Magnetic resonance enterography in refractory iron deficiency anemia: A pictorial overview

Cengic, Ismet; Türeli, Derya; Aydin, Hilal; Bugdayci, Onur; İmeryüz, Neşe; Tüney, Davut

doi:10.3748/wjg.v20.i38.14004

Cited by 5 publications

(8 citation statements)

References 29 publications

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“…However, this review did not distinguish individuals with overt versus occult bleeding. The diagnostic yield of small bowel imaging speci cally in those without overt bleeding is likely much lower, as evidenced by a study conducted by Cengic et al, in which MRE detected positive ndings in 7.5% of patients with refractory iron de ciency anemia, including 2 patients with malignancy (1 adenocarcinoma, 1 lymphoma), 1 with Crohn's disease, and 1 with antral gastritis that was later seen on repeat gastroscopy [10]. To our knowledge, no other studies have reported detection rates of CSLs in small bowel investigations among patients with IDA without overt bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…While historical studies have reported rates of CSLs in the small bowel in the context of IDA ranging from 32% to 78% [9] following negative EGD and colonoscopy, most of these studies included patients with overt and occult bleeding. The few studies that have speci cally evaluated obscure occult IDA cite much lower rates of positive ndings, with MR enterography being normal in 92.5% of subjects in one study [10]. Nevertheless, many practitioners may feel compelled to proceed with small bowel investigations, particularly in elderly individuals, for fear of missing small bowel cancers, Crohn's disease or vascular ectasias that are at risk of re-bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Hae¹,

Murthy²

2019

Preprint

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Background Iron deficiency anemia in the absence of overt bleeding can result from chronic occult blood loss from the gastrointestinal tract. When esophagogastroduodenoscopy (EGD) and colonoscopy fail to demonstrate clinically significant lesions (CSLs), practitioners often consider small bowel investigations, such as CT enterography and video capsule endoscopy. Although most society guidelines recommend further investigations to evaluate the small bowel, few studies have evaluated the utility of small bowel radiographic imaging in this setting.Methods This is a retrospective cross-sectional study investigating the rates and types of CSLs identified during EGD, colonoscopy and small bowel imaging among individuals over age 50 who were referred for new-onset iron deficiency anemia without overt bleeding. Data was collected on 334 consecutive patients who underwent colonoscopy with or without EGD to evaluate new-onset iron deficiency anemia at The Ottawa Hospital from January 1, 2010 to March 30, 2012. We evaluated the frequency of CSLs among all patients and those who further underwent small bowel radiographic imaging.Results Of the 332 individuals who underwent colonoscopy, 42 (12.7%) were found to have a CSL, with 37 of these being malignancy or high-grade adenomas. Of the 258 individuals who also underwent EGD, 49 (19.0%) had CSLs, including 11 vascular ectasias, 15 peptic ulcer disease, 8 celiac disease, 8 severe erosive esophagitis, and 9 esophageal varices. Of 243 patients who did not have any CSLs identified on colonoscopy +/- EGD, 75 underwent subsequent small bowel imaging, and 9 patients underwent small bowel imaging despite having a CSL found on endoscopy. A total of 84 patients underwent subsequent small bowel imaging (68 CT enterography, 13 small bowel follow-through, one MR enterography, one CT enteroclysis, and one push enteroscopy). In these 84 patients, only one relevant CSL was found (inflammatory bowel disease).Conclusions Upper and lower endoscopy are valuable tools for diagnosing gastrointestinal tract lesions in individuals over the age of 50 with newly diagnosed iron deficiency anemia in the absence of overt bleeding. CT enterography and small bowel follow-through have limited utility in this setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Hae¹,

Murthy²

2019

Preprint

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“…It can detect the mural thickening (>4 mm) and mass lesion of the small bowel. These lesions could be secondary to inflammatory and benign conditions (like Crohn's disease, adenoma, lipoma, fibroepithelial polyps) or malignant conditions (like neuroendocrine tumors, GIST, adenocarcinoma, lymphoma, and Peutz-Jeghers syndrome) [33,34].…”

Section: Mrementioning

confidence: 99%

Mid-Gastrointestinal Bleeding

Ahmed¹

2020

Digestive System - Recent Advances

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Mid-gastrointestinal bleeding constitutes a small proportion of all cases of gastrointestinal bleeding. It is more difficult to manage mid-gastrointestinal bleeding than upper or lower gastrointestinal bleeding. The etiology differs in younger and older age groups. The clinical presentation, investigations, and management are also different. Capsule endoscopy has improved the diagnostic accuracy to a great extent. Device-assisted enteroscopies (balloon-assisted enteroscopies and spiral enteroscopy) have both diagnostic and therapeutic potentials. Most of the time, patients present with obscure gastrointestinal bleeding which could be overt or occult. Another common presentation is iron deficiency anemia. A stepwise approach is essential to accurately diagnose and manage mid-gastrointestinal bleeding.

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“…After a 4–6 h fast, 1000–2000 cc of a biphasic water-based oral contrast similar to the ones used during CTE is administered, often with metoclopramide (10–20 mg po), followed by a gadolinium-based intravenous contrast (0.65 mg/kg) together with either hyoscine butylbromide (20 mg iv) or glucagon (0.5 mg iv). 5 , 6 …”

Section: Technical Characteristicsmentioning

confidence: 99%

“…Few studies have reported on the usefulness of MRE in the context of OGIB, but its use it limited by a lower spatial resolution than CTE, 5 reduced availability in the urgent setting, 6 and cost. 69 When compared to SBCE, MRE demonstrated a significantly inferior diagnostic yield (53% vs. 21%).…”

Section: Obscure Gastrointestinal Bleedingmentioning

confidence: 99%

Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel

Carvalho

Cotter

2016

GE Portuguese Journal of Gastroenterology

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Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE).The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications.SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance.These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.

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Magnetic resonance enterography in refractory iron deficiency anemia: A pictorial overview

Abstract: MRE is a non-invasive and effective alternative for evaluating possible malignancies of the small intestines and can serve as a guide for a second-look endoscopy.

Cited by 5 publications

References 29 publications

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Small Bowel Radiographic Imaging is Not Useful for Isolated Iron-Deficiency Anemia

Mid-Gastrointestinal Bleeding

Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel

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