Iron-deficiency anemia and hematochezia: when is colonoscopy appropriate?

TitleIron-deficiency anemia and hematochezia: when is colonoscopy appropriate?
Publication TypeConference Paper
Year of Publication2009
AuthorsGonvers, JJ, Juillerat, P, Peytremann-Bridevaux, I, Arditi, C, Froehlich, F, O'Malley, J, Fairclough, P, Le Moine, O, Dubois, R, Schusselé-Filliettaz, S, Vader, J-P, Pittet, V, Burnand, B
Conference Name77. Jahresversammlung der Schweizerischen Gesellschaft für Innere Medizin, Basel, 13.-15. Mai 2009
Conference LocationBasel, Schweiz 13.-15. Mai 2009
ISBN Number1424-3784
Accession Numberserval:BIB_CFDD43E8F0BB
KeywordsAnemia, Colonoscopy, Gastrointestinal Hemorrhage, Guidelines as Topic, Iron-Deficiency

Background: Colonoscopy is usually proposed for the evaluation of lower gastrointestinal blood loss (hematochezia) or iron deficiency anemia (IDA). Clinical practice guidelines support this approach but formal evidence is lacking. Real clinical scenarios made available on the web would be of great help in decision-making in clinical practice as to whether colonoscopy is appropriate for a given patient. Method: A multidisciplinary multinational expert panel (EPAGE II) developed appropriateness criteria based on best published evidence (systematic reviews, clinical trials, guidelines) and experts' judgement. Using the explicit RAND Appropriateness Method (3 round of experts' votes and a panel meeting) 102 clinical scenarios were judged inappropriate, uncertain, appropriate, or necessary. Results: In IDA, colonoscopy was appropriate in patients >50 years and necessary in the presence of lower abdominal symptoms. In both men and women aged 50 years with hematochezia, colonoscopy was always appropriate and mostly necessary, except if a prior colonoscopy was normal within the previous 5 years. Under age 50 years, the presence of any risk factor for colorectal cancer (CRC) and no previous normal colonoscopy (within the last 5 years) made this procedure appropriate and necessary. Conclusion: Colonoscopy is appropriate and even necessary for many indications related to iron deficiency anemia or hematochezia, in particular in patients aged >50 years. The main factors influencing appropriateness are age, results of prior investigations (sigmoidoscopy, gastroscopy, previous colonoscopy), CRC risk and sex. EPAGE II appropriateness criteria are available on


Citation Key / SERVAL ID4723


Institute of Social and Preventive Medicine
Route de la Corniche 10, 1010 Lausanne - Switzerland
+41 21 314 72 72 |

Go to top