Prevalence of gastrointestinal malignancy in non-anemic iron deficiency and significance for endoscopic screening: A Western Australian multicenter cohort study.

BACKGROUND AND AIM: There is a paucity of evidence regarding non-anemic iron deficiency as a predictor for colorectal cancer and therefore the indication for endoscopic evaluation. This study explores the rates of malignancy in adults with iron deficiency with and without anemia. METHODS: A retrospective multicenter diagnostic cohort study was conducted across two Australian health services. All cases that underwent both esophagogastroduodenoscopy and colonoscopy between September 1, 2018, and December 31, 2019, for the investigation of iron deficiency were included, and the cohort was divided into anemic and non-anemic arms. Multivariate binomial logistic regression was performed to establish clinical characteristics associated with neoplasia. RESULTS: Five hundred eighty-four patients underwent endoscopic evaluation over a 16-month period. There was a significantly higher rate of malignancy in the iron deficiency anemia arm as compared with those without anemia (8.76% vs 1.20%, P < 0.01). Gastrointestinal pathology to account for iron deficiency was identified in > 60% of the total cohort. The presence of anemia (odds ratio [OR] 6.87, P < 0.01) and male gender (OR 3.01, P = 0.01) were significant predictors of malignancy. CONCLUSION: This study demonstrates that anemic iron deficiency confers a significantly greater risk of gastrointestinal cancer compared with non-anemic iron deficiency. Additionally, over 60% of patients had gastrointestinal pathology to account for iron deficiency overall, supporting the need to perform baseline endoscopy in patients with iron deficiency.

Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception.

An anonymous questionnaire-based survey was used to determine current practices and opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures, regarding the routine use of histopathology for products of conception (POC) obtained either from the surgical management of miscarriage or termination of pregnancy. Sixty-one senior health professionals completed the survey. Tissue histopathology on POC was routinely requested for miscarriage and termination of pregnancy (TOP) by 87 and 59% of respondents, respectively. Respondents listed the main reasons for requesting routine histopathology as avoidance of misdiagnosis, medico-legal and quality assurance. There were inconsistent practices among WA health professionals regarding sending POC for histopathology; 63% of gynaecology head of departments recommend the introduction of state or national guidelines for the use of histopathology in the surgical management of miscarriages or terminations of pregnancy.

Looking for the second patient: current practice and opinion on pre-operative pregnancy testing in Western Australia.

INTRODUCTION: To determine current hospital practices and the opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures regarding pre-operative pregnancy testing. METHODS: Anonymous questionnaire survey sent to all WA public and private hospitals' senior clinical staff (38 units where gynaecological surgery was performed in WA). RESULTS: Sixty-one senior health professionals (heads of department, medical directors, theatre nurse managers), completed the survey (estimated response rate 71%). Thirty-eight (68%) of respondents' units had guidelines for pre-operative pregnancy testing and 55% respondents worked in hospitals which tested all women of reproductive potential. Nineteen (33%) respondents reported cases in which patients had presented for surgery unaware they were pregnant. Forty-one (76%) respondents believed that all women of reproductive potential should have routine pre-operative pregnancy testing. Fifty-four (89%) supported the introduction of national or statewide guidelines. DISCUSSION: There are inconsistent processes of pre-operative assessment of pregnancy status in WA hospitals performing gynaecological surgery potentially resulting in adverse incidents. The majority of senior clinical staff surveyed supported routine pre-operative testing and the need for national or statewide guidelines.