P1361 - Food Bolus Removal and Biopsy Practices in Esophageal Food Impactions at a Tertiary Care Center: There Is a Lot of Room for Quality Improvement

Pradeep Kathi, MD¹, Kayvon Moazam, DO¹, Michael Bonelli, DO¹, David Kim, MD², Bhaskar Banerjee, MD^1
1Banner University Medical Center, Tucson, AZ; ²Austin Gastroenterology, Tucson, AZ

Introduction: Current evidence recommends evaluation for Eosinophilic esophagitis (EoE) when suspected in patients with esophageal food impactions (EFI) even in the presence of normal mucosa. It is also recommended that during Esophagogastroduodenoscopy (EGD) the impacted food is not pushed away due to the risk of perforation. Aims of the study were to assess the common methods of dis-impaction and biopsy practices on evaluation for EoE in patients with EFI.

Methods: We performed a 7-year retrospective analysis of all adult cases of EFI who had an EGD between 11/2011 - 11/2018 at a tertiary care center. Inclusion criteria: any adult patient who had an EGD for EFI in the study period. Patient demographics, predisposing conditions, method of food bolus removal, findings after dis-impaction, biopsies for EoE evaluation, procedural complications were compiled.

Results: A total of 183 patients with EFI aged 18 and above were included: mean age was 54 and 67% were male. Race/ethnicity: 96% Caucasian, 1% African American, 1%, American Indian, 1% Asian, 1% others; 30% were Hispanic/Latino. History of EFI was present in 52% and 7% had known EoE. Esophageal Food bolus was present in the esophagus in 82% of patients and the most common method of disimpaction was push technique alone 49%, combination of various techniques 29%, suction cap alone 14%, Roth net 4%, forceps 3%, not documented 1%. Iatrogenic esophageal perforation was suspected in 3 patients and confirmed in 1 patient (< 1%), with the push technique used in all.
Although EoE was considered in the differential of 55% of patients, biopsies for EoE were obtained only in 47% of suspected cases. Only 11 of 45 patients who were recommended to have repeat EGD had returned for the appointment (Table 1). Patients with endoscopic findings of EoE were more likely to have biopsies on index EGD compared to those without (P < 0.05).

Discussion: Our study highlights the real-world data that despite the recommendations to the contrary, there is a tendency to use the push technique in the majority of EFI. Mucosal biopsies for evaluation of EoE were not obtained in > 50% suspected cases with a follow-up rate of only 24% for a repeat EGD to obtain biopsies. Clinicians should be cognizant of this poor follow-up rate and EoE should be evaluated on the index EGD in suspected cases even with normal mucosa as delay in diagnosis could lead to worse outcomes.



Disclosures:


Pradeep Kathi, MD¹, Kayvon Moazam, DO¹, Michael Bonelli, DO¹, David Kim, MD², Bhaskar Banerjee, MD¹. P1361 - Food Bolus Removal and Biopsy Practices in Esophageal Food Impactions at a Tertiary Care Center: There Is a Lot of Room for Quality Improvement, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.