P4881 - Predictors of Low Esophageal Biopsy Rates During Endoscopy for Food Impaction and Resultant Delayed Diagnosis and Missed Cases of Eosinophilic Esophagitis in a National Veteran Population

Eric E. Low, MD, MPH¹, Joy W. Chang, MD, MS², Walker D. Redd, MD, MSCR³, Rena Yadlapati, MD⁴, Samir Gupta, MD⁴, Shailja Shah, MD⁵, Evan S. Dellon, MD, MPH⁶, Yash Choksi, MD⁷
1Jennifer Moreno Veteran Affairs San Diego Healthcare System, University of California, San Diego, CA; 2Michigan Medicine, Ann Arbor, MI; 3Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC; 4University of California San Diego, San Diego, CA; 5Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, CA; 6Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC; 7Vanderbilt University, Nashville, TN

Introduction: Best practice guidelines recommend obtaining esophageal biopsies during an index food impaction to evaluate for eosinophilic esophagitis (EoE). We performed a retrospective study using a national sample to evaluate rates of esophageal biopsy during an index foreign body/food impaction and assess outcomes related to EoE diagnoses.

Methods: We utilized national VA data to identify adults ≥18 years of age diagnosed with a first esophageal foreign body (FB) (ICD-9 and -10 codes) or food impaction (FI) (ICD-10 codes) between 01/01/2008 (first ICD codes for EoE) and 12/31/2023. Diagnoses of esophageal cancer were excluded. Descriptive statistics characterizing biopsy rates and time to EoE diagnosis were performed. Multivariable regression analyses were used to evaluate factors associated with obtaining biopsies.

Results: 7,547 unique patients in the VHA (median age 68, 96% male, 81% white) underwent an EGD for an index esophageal FB/FI. Esophageal biopsies were collected in 28.5% (2,153/7,547) of these patients. 10.3% (778/7,547) of patients had biopsies documented from multiple esophageal levels. Biopsy frequency was significantly higher following the EoE guidelines in 2018 (31.1%) compared to previous years (26.7%) (p< 0.0001). Figure

10% (755/7,547) of the cohort had a diagnosis of EoE: 38% diagnosed at the time of index FB/FI, and 62% after presentation. Median delay in EoE diagnosis was 103 days from index FB/FI (Q1-Q3: 39-473 days). 43.1% (3,256/7,547) of the total cohort never had documented esophageal biopsies collected during their lifetime in the VA system.

In multivariable analyses, younger age, performing an “overnight” vs “daytime” endoscopy, male vs female sex, and lower VA facility complexity were associated with obtaining biopsies. Race, ethnicity, and use of propofol during the procedure did not significantly impact biopsy rates. Table

Discussion: In a national sample, less than 1 in 3 patients presenting with an index FB/FI and who underwent an EGD had esophageal biopsies obtained during the procedure. Older patients and females were at higher risk for not having biopsies collected. More than half of EoE cases were diagnosed after this index presentation, with a median delay in diagnosis of 103 days. Almost 1 in 2 FB/FI patients never had esophageal biopsies collected, suggesting hundreds of EoE cases may have been missed. Adherence to the best practice recommendation of obtaining esophageal biopsies during index FI may improve EoE diagnosis timing and initiation of treatment.


Figure: Percentage of Patients with Esophageal Biopsies Collected during an Endoscopy for Index Foreign Body/Food Impaction by Year


Figure: Multivariable Regression Model for Key Variables to Predict Odds of Obtaining Biopsies During a Procedure (Yes a biopsy was collected vs No a biopsy was collected)

Disclosures:
Eric E. Low indicated no relevant financial relationships.
Joy Chang: Bristol Myers Squibb – Consultant. Sanofi-Regeneron – Consultant. Takeda – Consultant.
Walker Redd: Sanofi – Consultant.
Rena Yadlapati: Braintree – Consultant. Medtronic – Consultant. Phathom Pharmaceuticals – Consultant. Reckitt Benckiser – Consultant. RJSMediagnostix – Advisory Committee/Board Member.
Samir Gupta: Geneoscopy – Consultant. Guardant Health – Consultant. Universal Diagnostics – Consultant.
Shailja Shah indicated no relevant financial relationships.
Evan Dellon: AbbVie – Consultant. Adare/Ellodi – Consultant, Grant/Research Support. Akesobio – Consultant. Alfasigma – Consultant. ALK – Consultant. Allakos – Consultant, Grant/Research Support. Amgen – Consultant. Apogee – Consultant. Apollo – Consultant. Aqilion – Consultant, Grant/Research Support. Arena/Pfizer – Consultant, Grant/Research Support. Aslan – Consultant. AstraZeneca – Consultant, Grant/Research Support. Avir – Consultant. Biocryst – Consultant. Bryn – Consultant. Calypso – Consultant. Celgene/Receptos/Bristol Myers Squibb – Consultant, Grant/Research Support. Celldex – Consultant, Grant/Research Support. Dr. Falk Pharma – Consultant. EsoCap – Consultant. Eupraxia – Consultant, Grant/Research Support. Ferring – Consultant, Grant/Research Support. GI Reviewers – Consultant. GSK – Consultant, Grant/Research Support. Holoclara – Consultant, Grant/Research Support. Invea – Consultant, Grant/Research Support. Knightpoint – Consultant. LucidDx – Consultant. Meritage – Grant/Research Support. Miraca – Grant/Research Support. Morphic – Consultant. Nexstone Immunology/Uniquity – Consultant. Nutricia – Consultant, Grant/Research Support. Parexel/Calyx – Consultant. Phathom – Consultant. Regeneron Pharmaceuticals Inc. – Consultant, Grant/Research Support. Revolo – Consultant, Grant/Research Support. Robarts/Alimentiv – Consultant. Sanofi – Consultant, Grant/Research Support. Shire/Takeda – Consultant, Grant/Research Support. Target RWE – Consultant. Third Harmonic Bio – Consultant. Uniquity – Grant/Research Support. Upstream Bio – Consultant.
Yash Choksi indicated no relevant financial relationships.

Eric E. Low, MD, MPH¹, Joy W. Chang, MD, MS², Walker D. Redd, MD, MSCR³, Rena Yadlapati, MD⁴, Samir Gupta, MD⁴, Shailja Shah, MD⁵, Evan S. Dellon, MD, MPH⁶, Yash Choksi, MD⁷. P4881 - Predictors of Low Esophageal Biopsy Rates During Endoscopy for Food Impaction and Resultant Delayed Diagnosis and Missed Cases of Eosinophilic Esophagitis in a National Veteran Population, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.