{
  "abstract": "Introduction At oesophago-gastro-duodenoscopy (OGD) the BSG recommends taking ≥6 oesophageal biopsies from ≥2 anatomical levels in adults with endoscopic signs associated with EoE, or symptoms of dysphagia or food bolus obstruction, with a normal oesophagus. Inappropriate sampling may cause diagnostic uncertainty, delay, and repeat OGD. We evaluated oesophageal biopsy practice in a large secondary care hospital to assess guideline adherence, histological yield, and clinical outcome in dysphagia referrals.Methods We retrospectively evaluated adult OGDs for dysphagia at a University Teaching Hospital from 2023 to 24. Data including endoscopist, prior OGD, biopsy number, level and histology findings were collected from electronic records. Diagnostic yield was defined as a histological diagnosis of EoE. A final diagnosis of EoE was confirmed on review of clinic correspondence excluding other causes of oesophageal eosinophilia. Analyses used chi-squared and Mann–Whitney U tests.Results In total 3818 OGDs were identified, 609/3818 were excluded due to malignancy and causes of dysphagia not in-keeping with EoE, leaving 3209 procedures for analysis. Biopsies were taken in 53.4% (1714/3209) procedures, with full adherence to BSG guidance in 14.4% (461/3209).Among biopsied patients 4.1% (70/1714) had sufficient eosinophilia for a histological diagnosis of EoE. Where biopsy number was recorded, yield increased from 1.1% with 2 biopsies, 3.7% with 3, to 4.6% with 6 biopsies. Yield was higher when guidance was followed (5.6% vs 1.6% p<0.001).EoE was clinically confirmed in 60/70 patients (median age: 40.5, age range 19-79); 70% (42/60) were male. Classic macroscopic features occurred in 40% (24/60), and atopy in 57% (34/60). Prior use of acid suppressive medication was noted in 39% (23/60), and 25% (15/60) were taking it at the time of endoscopy. Oro-dispersible steroids were started in 42/60 patients; follow-up data was available for 19/42 patients, 19/19 improved. The remaining 14% (10/70) (median age: 56.5, age range 30-66, p=0.08) were managed as gastro-oesophageal reflux disease.Sampling varied by clinician, with highest adherence among trust-grade doctors: 43.8% (121/276), and greater adherence among consultant gastroenterologists than consultant surgeons (27.8%vs16.0% p=0.04).Among 453 patients that had a prior OGD for dysphagia within 5 years, 51.9% (235/453) had not previously undergone oesophageal biopsy, and 2.1% (5/235) later had histological EoE, reflecting potential missed diagnostic opportunities. Conversely of the 218/453 biopsied at previous gastroscopy 115 had a repeat biopsy.Conclusion Adherence to biopsy guidance in patients with dysphagia is low. There is both low yield and a significant false positive rate. Our data would support focusing on factors such as education, pertinent history, repeat OGD without previous biopsy and EoE signs at OGD to optimise diagnosis.",
  "authors": [
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Alexander Lal"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Connor Cotton"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Carmen Chen"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Aishwarya Devanand"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Suneil Raju"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom"
      ],
      "name": "Kumar Basu"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom",
        "Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, S10 2TN, Sheffield, United Kingdom"
      ],
      "name": "Andrew Hopper"
    },
    {
      "affiliations": [
        "Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, United Kingdom",
        "Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, S10 2TN, Sheffield, United Kingdom"
      ],
      "name": "David Sanders"
    }
  ],
  "title": "FP31 Adherence to BSG eosinophilic oesophagitis biopsy guidance in dysphagia",
  "uid": "1fdd422c-b961-5edf-a3c7-251966e027fb"
}