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Endoscopy
Original research
Tailoring follow-up endoscopy in patients with severe oesophagitis
  1. Rebecca K Grant1,
  2. William M Brindle1,2,
  3. Caitlyn L Taylor1,
  4. Edward J Rycroft1,
  5. Oluwadara Oyewole1,
  6. Sarah C Morgan1,
  7. Eleanor F Watson3,
  8. Atul Anand4,
  9. Norma C McAvoy1,
  10. Ian D Penman1,
  11. Nicholas I Church1,
  12. Kenneth C Trimble1,
  13. Colin L Noble3,
  14. John N Plevris1,
  15. Gail S M Masterton1,
  16. Rahul Kalla1
  17. on behalf of EGAR (Edinburgh GI Audit and Research) Collaborative
    1. 1 The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
    2. 2 Victoria Hospital, Department of Gastroenterology, NHS Fife, Kirkcaldy, Fife, UK
    3. 3 The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK
    4. 4 Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
    1. Correspondence to Dr Rebecca K Grant, The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; rebecca.x.grant{at}nhslothian.scot.nhs.uk

    Abstract

    Objective We aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett’s oesophagus (BO), cancer, dysplasia and strictures. Second, we aimed to determine if the Clinical Frailty Scale (CFS) may be used to identify patients to undergo OGD2s.

    Design/method Patients in NHS Lothian with an index OGD (OGD1) diagnosis of severe oesophagitis between 1 January 2014 and 31 December 2015 were identified. Univariate analysis identified factors associated with grade. Patients were stratified by frailty and a diagnosis of stricture, cancer, dysplasia and BO.

    Results In total 964 patients were diagnosed with severe oesophagitis, 61.7% grade C and 38.3% grade D. The diagnostic yield of new pathology at OGD2 was 13.2% (n=51), new strictures (2.3%), dysplasia (0.5%), cancer (0.3%) and BO (10.1%). A total of 140 patients had clinical frailty (CFS score ≥5), 88.6% of which were deceased at review (median of 76 months). In total 16.4% of frail patients underwent OGD2s and five new pathologies were diagnosed, none of which were significantly associated with grade. Among non-frail patients at OGD2, BO was the only pathology more common (p=0.010) in patients with grade D. Rates of cancer, dysplasia and strictures did not vary significantly between grades.

    Conclusion Our data demonstrate that OGD2s in patients with severe oesophagitis may be tailored according to clinical frailty and only be offered to non-frail patients. In non-frail patients OGD2s have similar pick-up rates of sinister pathology in both grades of severe oesophagitis.

    • oesophagitis
    • erosive oesophagitis
    • endoscopy
    • ageing

    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, RKG, upon reasonable request.

    https://doi.org/10.1136/flgastro-2023-102485

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      Data availability statement

      Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, RKG, upon reasonable request.

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      Footnotes

      • Twitter @rebeccakg6, @AKA_Dr_E_Watson, @GastronautIan, @john_plevris, @rahul_kalla

      • Collaborators The following listed authors are members of the Edinburgh GI Audit and Research (EGAR) collaborative: EFW, NCM, IDP, NIC, KCT, CLN, JNP, GSMM and RK. Their contributions are listed in the author contributions section. Additional members of the collaborative, who did not contribute directly to the paper (and are therefore not included in the author contributions section) are as follows: Dr Anne G J Dethier, Dr Shahida Din, Dr Aaron P McGowan, Dr Sarah E Minnis-Lyons and Dr Benjamin M Shandro.

      • Contributors RKG contributed to conception of the work, data collection, statistical analysis and drafted the original manuscript. WMB contributed to conception of the work, data collection and revision of the manuscript. CT contributed to data collection, statistical analysis and revision of the manuscript. EJR, OO, SCM and EFW contributed to data collection and revision of the manuscript. AA, NCM, IDP, NIC, KCT, CLN and JNP critically revised the manuscript. GSMM contributed to conception of the work and critically revised the manuscript. RK was senior author and contributed to conception of the work and critically revised it for important intellectual content. Guarantor: RKG.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

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