P2979 - Upper Endoscopic Evaluations Resulting From Abnormal Imaging Study of Upper GI Tract Display Poor Concordance

Jawaid Shaw, MD, MS¹, Sharanya Deshmukh, ¹, Niki Wadhwa, MD¹, Alok Baral, MD¹, Maryam Shaw, ², Arsany Habib, ³, Ekaterina Smirnova, PhD⁴, Sanjeev Jairath, MD¹
1Virginia Commonwealth University Medical Center, Richmond, VA; 2Virginia Commonwealth University, Richmond, VA; 3Reynolds Community College, Richmond, VA; 4Virginia Commonwealth University School of Public Health, Richmond, VA

Introduction: Abdominal imaging modes like CT scans are performed to evaluate patients (pts) with GI symptoms. These modalities report abnormalities like gastric wall thickening etc. which invariably lead to EGD evaluation. This approach is not delineated and ordering an EGD for every abnormal imaging burdens the US health care system. We aimed to find the yield of the EGDs resulting from an abnormal imaging study.

Methods: The pts were selected from Virginia Commonwealth University (VCU) Health's provation system. All pts ≥18 years of age who underwent an EGD for indication of abnormal imaging from 2017 to 2024 were included. Excluded were those with a diagnosis of active GI bleeding during current admission and/or with a known upper GI cancer.

Results: We identified 548 pts and collected data in VCU's "RedCap." Demographic data, BMI, details of abdominal imaging, GI symptoms, past GI history, and EGD findings were collected. The mean age of the pts was 57.5 years, with comparable sex and racial distribution; males 277(50.5%) vs. females 271(49.5%), & white 264(48.2%) vs. black 261(47.6%). The mean BMI was 27.2 kg/cm².
Main CT findings included diffuse & focal thickening in the stomach and GE junction in 39%, mass in stomach 6.2%, hiatal hernia 6.2%, filling defect in stomach 1.3%, & ulcer in stomach 1.1%. Other findings were reported in 46%. Main EGD Findings normal EGD findings were found in 23.4%. There were only 2.7% & 1.6% pts whose both CT scan and EGD showed a mass & hiatal hernia respectively (concordant findings). Focal thickening & EGD findings in stomach found in 17.3%, normal EGD 16.8%, gastritis 18.9%, hiatal hernia 11.6%, ulcer 8.4%, polyp 7.4%, mass 3.2%. 44.2% had an esophageal & 11.6% had a duodenal abnormality. Diffuse thickening and EGD findings in stomach found in 8.2%, with normal EGD in 24.4%, hiatal hernia 8.9%, mass 8.9%, polyp 6.7%, gastritis 6.7%, ulcer in 4.4%. 13.3% & 6.7% pts showing esophageal & duodenal abnormality respectively. Thickening at the GE junction: found in 8.9%, with normal EGD in 24.5%, hiatal hernia 18.4%, gastritis 6.1%. 4.1% & 2.0% had a mass and polyp in stomach respectively. 46.9% & 10.2% had an esophageal & duodenal abnormality respectively.

Discussion: Our study highlights the sparse concordance between EGD and CT scan findings in a real-world sample. Thickening is the most common finding triggering an EGD. The challenge is to optimize EGD resources. A scoring system derived from imaging and clinical parameters might inform us of proper selection.

Disclosures:
Jawaid Shaw indicated no relevant financial relationships.
Sharanya Deshmukh indicated no relevant financial relationships.
Niki Wadhwa indicated no relevant financial relationships.
Alok Baral indicated no relevant financial relationships.
Maryam Shaw indicated no relevant financial relationships.
Arsany Habib indicated no relevant financial relationships.
Ekaterina Smirnova indicated no relevant financial relationships.
Sanjeev Jairath indicated no relevant financial relationships.

Jawaid Shaw, MD, MS¹, Sharanya Deshmukh, ¹, Niki Wadhwa, MD¹, Alok Baral, MD¹, Maryam Shaw, ², Arsany Habib, ³, Ekaterina Smirnova, PhD⁴, Sanjeev Jairath, MD¹. P2979 - Upper Endoscopic Evaluations Resulting From Abnormal Imaging Study of Upper GI Tract Display Poor Concordance, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.