P0297 - Adherence to Major Society Recommendations in Patients Diagnosed with Esophagogastric Outflow Obstruction in a Large Tertiary Academic Center: A Retrospective Analysis

Tanmay Gaglani, MD, Yllen Hernandez Blanco, MD, Seifeldin Hakim, MD, Zubair Khan, MD, Blake Purtle, MD, Brooks D. Cash, MD, FACG
University of Texas Health Science Center at Houston, Houston, TX

Introduction: Patients diagnosed with esophagogastric junction outflow obstruction (EGJOO) with high resolution manometry (HRM) are recommended to be evaluated with additional imaging modalities such as barium swallow (BaSw), CT, or endoscopic ultrasound (EUS) to exclude secondary etiologies of the elevated integrated relaxation pressure central to the diagnosis of EGJOO. We retrospectively evaluated adherence and yield with these recommendations at a large tertiary referral center.

Methods: Patients undergoing HRM and diagnosed with EGJOO from January 2016 to December 2019 were included in this analysis. Demographics and HRM parameters were collected and, using a central electronic medical record (EMR), patient records were examined over 1 year from the time of diagnosis of EGJOO to determine if subsequent imaging modalities were obtained and if so, whether an explanation for EGJOO was identified.

Results: A total of 117/1800 (6.5%) patients were diagnosed with EGJOO. Ninety patients (76.9%) were female, 9 (7.7%) had undergone antireflux surgery prior to HRM, and 2 (1.7%) had undergone bariatric surgery prior to HRM. Narcotic use was present in 7 (6.0%) at the time of HRM. A total of 116 follow up imaging studies were ordered within 1 year of the EGJOO diagnosis and 75 patients (64.1%) completed additional imaging within 1 year, with 34 (45%) undergoing multiple studies (Table 1). 26 patients (22.2%) underwent EUS and 11 (42.3%) of these examinations explained the EGJOO. 48 patients (41.0%) underwent CT and an explanation for EGJOO was found in 8 of these patients (16.6%). Finally, 42 patients underwent BaSw with 25 (59%) of these tests demonstrating an explanation for EGJOO (Fig 1).

Discussion: Additional imaging with BaSw, CT, or EUS is recommended in patients diagnosed with EGJOO. Among 117 patients diagnosed with EGJOO at a tertiary medical center, one-third did not undergo additional imaging within 1 year of their EGJOO diagnosis. Among patients who did undergo additional imaging, CT and BaSw were the most commonly used modalities. When obtained, additional imaging was felt to explain EGJOO in 58.7% of patients diagnosed with EGJOO on HRM. Prospective studies evaluating the compliance and yield of additional imaging after EGJOO diagnosis are needed.


Figure: Figure 1: Corroboration of EGJOO on subsequent imaging modalities

Patients diagnosed with EGJOO on HRM	Patients with imaging within one year of EGJOO diagnosis
117	75
CT Chest/Abd alone	26
CT Chest/Abd and EUS	4
CT Chest/Abd and Barium Swallow	11
Barium Swallow alone	12
Barium Swallow and EUS	12
EUS alone	3
EUS, CT Chest/Abd, and Barium Swallow	7

Table: Table 1: Adherance to EGJOO Imaging Recommendations


Disclosures:
Tanmay Gaglani indicated no relevant financial relationships.
Yllen Hernandez Blanco indicated no relevant financial relationships.
Seifeldin Hakim indicated no relevant financial relationships.
Zubair Khan indicated no relevant financial relationships.
Blake Purtle indicated no relevant financial relationships.
Brooks Cash indicated no relevant financial relationships.


Tanmay Gaglani, MD, Yllen Hernandez Blanco, MD, Seifeldin Hakim, MD, Zubair Khan, MD, Blake Purtle, MD, Brooks D. Cash, MD, FACG. P0297 - Adherence to Major Society Recommendations in Patients Diagnosed with Esophagogastric Outflow Obstruction in a Large Tertiary Academic Center: A Retrospective Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.