P0423 - Diagnostic Yield of Upper Endoscopy in Patients Referred for Esophagogastroduodenoscopy (EGD)

Sandy Chan, MD¹, Hatim Vajihi, MD², Neil B. Marya, MD¹, David Cave, MD, PhD^1
1UMass Memorial Medical Center, Worcester, MA; ²UMass Memorial Medical Center, Andover, MA

Introduction: Esophagogastroduodenoscopy (EGD) is an invasive technique that allows for direct visualization and intervention in the esophagus, stomach, and proximal duodenum. Literature on the diagnostic yield of upper gastrointestinal endoscopy is sparse with the majority of studies reporting on overseas populations. We tested the hypothesis that there may be opportunities for alternative non-invasive tests for screening low-risk patients.

Methods: We conducted a retrospective review of the diagnostic and intervention rate for EGD in all patients undergoing EGD in January and July of 2019 at a large tertiary care institution in 3 different settings. Demographic data, including age, sex, race, medical history, and medication use was collected for each patient (n=900) as well as indication and findings/intervention. Results were analyzed using the Chi-square test.

Results: 900 patients underwent EGD in the months of January and July. Average age was 57.32 +/- 16.58 (range 18-95) with 404 female patients (44.84%). The majority of the patients identified as white (n=576, 64%). Patients receiving EGD for indication of abdominal pain (74/150, 49.33%), melena (18/61, 29.51%), dysphagia (51/185, 27.57%), and nausea or vomiting (12/36, 33.33%) had the highest percentage of normal findings (Table 1). The diagnostic yield was examined after excluding patients who had alarm features (weight loss, nausea/vomiting, dysphagia) or surveillance (variceal, foreign body, known Barrett’s esophagus, hematemesis/melena) and the remaining patients were found to have no findings in 44.64% of patients (n=208/466). Patients who had EGD at an outpatient endoscopy clinic or outpatient endoscopy at the hospital had higher numbers of biopsies when compared to patients who received EGD at the hospital. Biopsies showed no findings or gastritis/duodenitis/esophagitis in 35% of patients at the outpatient endoscopy clinic, compared to 54% in outpatient endoscopy at the hospital and 15.35% of biopsies conducted in the hospital (p=0.01).

Discussion: EGD has a large proportion of negative results in the outpatient setting. The results of the majority of biopsies do not require treatment. Trans-nasal endoscopy and magnetically controlled capsule endoscopy are alternatives to EGD and do not require anesthesia. Prospective randomized studies of these techniques are needed to validate their use in low-risk populations as alternatives to EGD in the USA.

Indication for EGD/Diagnostic EGD Findings	Hemetemesis	Melena	Anemia	GERD/ Heartburn	Dysphagia	Nausea/ Vomiting	Weight Loss	Foreign Body	Barrett's Esophagus	Variceal Surveillance	Abdominal Pain	Ulcer	Misc
Normal	4 (18.2%)	18 (29.5%)	30 (42.4%)	65 (47.5%)	51 (27.6%)	12 (33.3%)	1 (8.3%)	2 (13.3%)	18 (32.73%)	6 (12.5%)	74 (49.3%)	6 (42.9%)	33 (36.7%)
Esophagitis/ Duodenitis/ Gastritis	3 (13.6%)	6 (9.8%)	9 (12.7%)	21 (15.3%)	31 (16.8%)	10 (27.8%)	4 (33.3%)	3 (20%)	1 (1.8%)	0 (0%)	29 (19.3%)	1 (7.1%)	12 (13.3%)
Eosinophilic Esophagitis	0 (0%)	0 (0%)	0 (0%)	1 (0.7%)	12 (6.5%)	0 (0%)	2 (16.7%)	2 (13.3%)	0 (0%)	0 (0%)	1 (0.7%)	0 (0%)	2 (2.2%)
Polyp	2 (9.1%)	2 (3.3%	3 (4.2%)	23 (16.8%)	17 (9.2%)	4 (11.1%)	1 (8.3%)	1 (6.7%)	0 (0%)	2 (4.2%)	5 (3.3%)	1 (7.1%)	12 (13.3%)
Barrett's Esophagus	0 (0%)	2 (3.3%)	3 (4.2%)	10 (7.3%)	10 (5.4%)	1 (2.8%)	0 (0%)	0 (0%)	27 (49.1%)	1 (2.1%)	2 (1.3%)	0 (0%)	6 (6.7%)
Portal Hypertension	0 (0%)	4 (6.6%)	1 (1.4%)	0 (0%)	4 (2.2%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	13 (27.1%)	1 (0.7%)	0 (0%)	0 (0%)
Varices	2 (9.1%)	5 (8.2%)	3 (4.2%)	0 (0%)	5 (2.7%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	21 (43.8%)	0 (0%)	1 (7.1%)	1 (1.1%)
Ulcer	6 (27.3%)	14 (23%)	11 (15.5%)	1 (0.7%)	7 (3.8%)	2 (5.6%)	0 (0%)	2 (13.3%)	0 (0%)	2 (4.1%)	6 (4%)	2 (14.3%)	3 (3.3%)
Miscellaneous	5 (22.3%)	10 (16.4%)	11 (15.5%)	16 (11.7%)	48 (26%)	7 (19.4%)	4 (33.3%)	5 (33.3%)	9 (16.4%)	3 (6.3%)	32 (21.3%)	3 (21.4%)	25 (27.8%)
Total	22	61	71	137	185	36	12	15	55	48	150	14	94

Table: Diagnostic Yield of Esophagogastroduodenoscopy


Disclosures:
Sandy Chan indicated no relevant financial relationships.
Hatim Vajihi indicated no relevant financial relationships.
Neil Marya: Boston Scientific – Consultant.
David Cave: AnX Robotics – Grant/Research Support.


Sandy Chan, MD¹, Hatim Vajihi, MD², Neil B. Marya, MD¹, David Cave, MD, PhD¹. P0423 - Diagnostic Yield of Upper Endoscopy in Patients Referred for Esophagogastroduodenoscopy (EGD), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.