{
  "abstract": "Introduction Current BSG guidance recommends follow-up endoscopy (OGD) after grade D oesophagitis or oesophageal ulceration to exclude cancer or Barrett’s oesophagus (BO), while ESGE guidance extends this to severe oesophagitis (LA Grade C and D). Studies demonstrate a low yield for cancer at follow-up, with most detected at index OGD. 1 Given the burden, cost, and environmental impact of endoscopy, we assessed the clinical utility of follow-up OGD in severe oesophagitis by evaluating diagnostic yield, with a view to improving pathways.Methods We conducted a retrospective review of patients with severe oesophagitis at a single non-specialist UK hospital between January 2023 and December 2024. Patients with isolated oesophageal ulcers were excluded. Demographic data, OGD findings, and biopsies were recorded. The primary outcome was the yield of new clinically significant pathology (BO, stricture, or dysplasia/cancer) at index OGD (OGD1) and follow-up OGD (OGD2), and additional yield from OGD2. Secondary outcomes were to review reasons for not rescoping and potential missed pathology.Results 212 patients with severe oesophagitis were identified. 60.6% were male, median age 68y. 47/204 (22.2%) were ASA 3 or 4. Clinically significant pathology was identified at OGD1 in 15.6% (33/212), including dysplasia in 1 (0.5%) later found to be a cancer and 2 (0.9%) cancers. 102/212 patients had biopsies at OGD1 (48.1%). Among those undergoing follow-up, new significant pathology was identified in 15.9% (21/132), or 9.9% of the whole cohort. 80 (37.7%) patients did not undergo follow-up OGD, most commonly due to frailty, death or patient choice. The endoscopy database was reviewed at 1 year after index endoscopy and no PEUGIC was identified.Conclusions In this single-centre cohort, follow-up OGD for severe oesophagitis demonstrated a low diagnostic yield for cancer, while BO and strictures were detected in ¼ of patients. Follow-up OGD contributed to 39% of findings, but all cancer was identified at index OGD. These findings support existing literature and question the value of routine follow-up OGD. A more selective approach is appropriate such as encouraging index biopsies, using the Charlson Comorbidity Index, and less invasive follow-up strategies, such as Capsule sponge testing (CS) to detect BO, dysplasia and inflammation. In this cohort a CS pathway could potentially avoid over 100 endoscopies – a prospective study is planned.Reference Osborne R, et al. Utility of a follow-up endoscopy after a diagnosis of severe oesophagitis or oesophageal ulcer and predictors of cancer and dysplasia. Frontline Gastroenterology.Abstract FP23 Table 1Endoscopic yield in severe oesophagitisOGD findingsOGD1 (n=212)OGD2 (n=132)Overall yield (n=212)Additional yield of OGD2BO171633 (15.6%)16/33 (48%)Benign stricture13518 (8.5%)5/18 (28%)Dysplasia/cancer303 (1.4%)0Total33 215421/54 (39%)",
  "authors": [
    {
      "affiliations": [
        "East and North Hertfordshire Teaching NHS Trust, United Kingdom"
      ],
      "name": "Deji Oyefeso"
    },
    {
      "affiliations": [
        "East and North Hertfordshire Teaching NHS Trust, United Kingdom"
      ],
      "name": "Catherine Ogbechie"
    },
    {
      "affiliations": [
        "East and North Hertfordshire Teaching NHS Trust, United Kingdom"
      ],
      "name": "Danielle L Morris"
    }
  ],
  "title": "FP23 Severe oesophagitis: can we improve patient pathways and the appropriate use of endoscopy?",
  "uid": "2b773475-93e1-53f0-a657-7b1cc7685c5b"
}