63 - From ED to EoE: Improving Practices for Timely Diagnosis (Late-Breaking Abstract)

Rosa Yu, MD¹, Natalie Sanfratello, MPH², Megan M. Leo, MD², Frederic F. Little, MD², Alison Li, MPH³, Christopher S. Huang, MD²¹Boston Medical Center, Boston University School of Medicine, Boston, MA; ²Boston University Chobanian & Avedisian School of Medicine, Boston, MA; ³Boston University Barry M. Manuel Center for Continuing Education, Boston, MA

Introduction: Early diagnosis of Eosinophilic Esophagitis (EoE) is critical for timely treatment and avoidance of complications. With rising prevalence and frequent diagnostic delays, adults with undiagnosed EoE may present to the Emergency Department (ED) with esophageal food impaction (EFI) or dysphagia. Prompt endoscopy (EGD) with biopsies, ideally concurrent with treatment of impaction, is essential to confirm diagnosis and prevent loss to follow-up, ensuring optimal care.

Methods: From 10/2024-7/2025, our team carried out a QI project leveraging the Model for Improvement centering on biopsies during index EGDs for EFI and improving follow-up care for patients with dysphagia. The primary aim was to increase the biopsy rate during EGDs for patients presenting to the ED with EFI from 38% to 75% by July 31, 2025. Baseline data for this measure were collected via chart review for calendar year 2023. Patients were included in this cohort if they presented to the ED with EFI, required an emergent EGD, and had unknown EoE status. For our follow-up care cohort, patients were included if they presented to the ED with EFI or dysphagia not previously investigated endoscopically and without need for emergent EGD. Based on gap analysis findings, the project team implemented multiple interventions. In April 2025, we provided education to the GI team on the importance of biopsies during index EGDs and to the ED team on recognizing EoE symptoms. We implemented a rapid referral process where patients discharged without an EGD would be prioritized for an outpatient EGD within 2 weeks of their ED visit to expedite diagnostic testing. Lastly, we created patient education available in multiple languages for patients with EFI and dysphagia on the importance of receiving GI follow-up care.

Results: After the educational intervention in April 2025, our project data showed improvement from 44% of eligible biopsies taken from September 2024-March 2025 to 100% of eligible biopsies from April-July 2025. With the introduction of rapid referrals, referrals to GI for patients presenting to the ED with dysphagia and without need for an emergent EGD improved from 1.3% for September 2024 – March 2025 to 19.3% for April 2025–July 2025.

Discussion: Through targeted education and updated workflows between the ED and GI teams, we were able to significantly improve biopsy rate during index EGDs for EFI and referrals to GI for those not needing emergent EGDs to expedite EoE diagnosis and care.

Disclosures:
Rosa Yu indicated no relevant financial relationships.
Natalie Sanfratello indicated no relevant financial relationships.
Megan Leo indicated no relevant financial relationships.
Frederic Little indicated no relevant financial relationships.
Alison Li indicated no relevant financial relationships.
Christopher Huang: Olympus; Consultant.