Repeat Endoscopy for Recurrent Iron Deficiency Anemia: An (Un)Expected Finding from Southeast Asia

Excerpt

Recurrent or refractory iron deficiency anemia due to occult gastrointestinal bleeding is a condition seen commonly by both general physicians and gastroenterologists alike [1]. Simultaneous evaluation of the upper and lower gastrointestinal tract, i.e., with esophagogastroduodenoscopy (OGDS) and colonoscopy, has been shown to detect or exclude important causes such as gastrointestinal malignancy [2, 3]. However, this approach has a diagnostic yield of only 30%–50% [2‐4]. Numerous other investigations, including push enteroscopy, intraoperative enteroscopy, small bowel enteroclysis, mesenteric angiography, and radiolabeled red blood cell scanning [5], are currently available to search for a source of blood loss, which is commonly perceived to originate from the small intestine when the OGDS and colonoscopy is normal. A recent innovation known as wireless capsule endoscopy [6] has been added to this list, with significant clinical implications [7]. …