AB054. Normal mucosa: oesophageal biopsies for all?—biopsy practices fall short of recommendations in excluding eosinophilic oesophagitis in patients with dysphagia and normal endoscopy

Background: Eosinophilic oesophagitis (EO) is an immune-mediated chronic oesophageal disease characterized by dysphagia and eosinophil-predominant inflammation histologically. Endoscopic features are non-pathognomonic, therefore British Society of Gastroenterology (BSG) guidelines recommend two-site oesophageal biopsies for patients presenting with dysphagia to exclude EO, if no alternate aetiology is identified. We aimed to evaluate compliance with the above guidelines and the diagnostic yield of detecting significant eosinophilia from oesophageal biopsies in patients who underwent an oesophagogastroduodenoscopy (OGD) for new-onset dysphagia without another apparent cause.

Methods: A single-centre, retrospective analysis, between January 2017–December 2018 was performed. A database was created to include OGD’s performed for new-onset dysphagia. Endoscopy and histology reports were analysed for site, number of biopsies, and final histological diagnosis.

Results: In total 249 OGD’s were identified. One hundred and eleven (44.78%) patients had a diagnosis of non-obstructive dysphagia, with 135 (55.42%) having luminal findings explaining their dysphagia. Thirty (27.02%) patients with non-obstructive dysphagia had biopsies and only 1 patient had 2-site biopsies as per guidance. One patient in either group (0.9% and 0.7%) had a histological diagnosis of EO. Within the biopsied group 90% (n=27) were normal, 3.3% (n=1) showed reflux inflammation and 3.3% (n=1) HSV oesophagitis.

Conclusions: Compliance with regards to location and number of biopsies based evidence-based guidance is suboptimal. EO is an uncommon cause of dysphagia within our cohort. We believe that the low prevalence is secondary to insufficient compliance with guidance. Routine biopsies based on consensus recommendations in patients with normal-appearing oesophageal mucosa will prevent EO being under-diagnosed. We recommend a greater awareness and observation of the protocol for obtaining biopsies in OGD’s for dysphagia.

Keywords: Dysphagia; eosinophilic oesophagitis (EO); oesophagus; biopsy