Endoscopy for Iron Deficiency.

Postmenopausal women with iron deficiency are prime candidates for screening endoscopy and colonoscopy.

In a consecutive series of 66 patients with iron deficiency but no anemia, 53% had a clinically important lesion that was picked up by endoscopy and colonoscopy, Dr. Elizabeth H. Weinshel reported in a poster presentation at the annual Digestive Disease Week.

A gastrointestinal examination is commonplace for adults with anemia of unknown cause, but waiting until iron deficiency progresses to outright anemia risks allowing a lesion to progress and worsen.

For example, in the series of 66 patients with iron deficiency but no anemia, 5 patients were found to have a colon carcinoma. Four of these five patients had a Duke's stage A or B lesion, which is curable by surgery. The fifth patient had a stage C or D lesion, which is too advanced for surgical treatment.

In contrast, in a parallel series of 190 patients who underwent screening colonoscopy and endoscopy for anemia, 19 had a colon carcinoma. In this group, 14 of the 19 patients had an advanced, Duke's stage C or D cancer, said Dr. Weinshel of the VA New York Harbor Healthcare System in New York.

When iron deficiency is detected as an incidental finding, it should be followed by endoscopy and colonoscopy regardless of whether anemia is present. In general, about one-third to half of patients with iron deficiency will also have anemia, but whether to screen all postmenopausal women remains a question, she said.