S821 Real-World Study of Biopsy Practices During Food Impactions in the Emergency Department: Multi-State GI Practice

Introduction: Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease, and is now the most common cause of esophageal food impaction (EFI). However, clinicians often overlook the diagnosis of EoE when patients present to emergency department (ED) with an EFI. The objective of this study was to characterize the management of EFI cases during and after ED visits in the community setting. Methods: A retrospective cohort study using de-identified electronic medical records from a real-world data repository from 58 gastroenterology (GI) practices across 6 U.S. states (Latica) was performed from January 2018 to June 2024. Patients were included in the analysis if they had ≥1 ED visit with an associated International Classification of Disease (ICD-10) diagnosis code for EFI, ≥12 months of data after index ED visit, and age ≥18 years at index. Exclusion was previous diagnosis of EoE. Patient demographics and endoscopic follow-up were assessed following the index ED visit with EFI. Patients were considered lost to follow-up if they did not have any subsequent in-person outpatient clinic visit, telehealth visit or esophagogastroduodenoscopy (EGD) visit within 1 year of index within these practices. Biopsies collected at endoscopy were defined as ≥1 relevant Current Procedural Terminology (CPT) code for EGD with biopsy (43239). Patients were identified with EoE if they had at least one ICD-10 code of K20.0. Descriptive analyses were used for continuous variables as mean with standard deviation (SD) and N (%). Results: Two-thousand five-hundred sixty-six patients with EFI-related ED visit were identified. Two-thousand five-hundred thirty-four (98.8%) underwent EGD at the time of index ED visit, mean age at presentation was 59 (19) years and 1,231 (48.6%) were women. At the index EGD, 108 (4.3%) underwent a dilation, 739 (29.2%) had a code for biopsies, and of these, 191 (25.8%) received an EoE diagnosis. From the 1,795 (70.8%) patients who did not have biopsies collected during the index EGD, 837 (46.6%) were lost to follow up and only 206 (11.5%) had an outpatient follow up EGD performed within 1 year after the EFI-related ED visit. Conclusion: In this real-world study of community GI practices, a minority of patients had biopsies coded during their EFI-related ED visit and follow-up EGD rates were rare. If data are confirmed with procedure documentation, collection of esophageal biopsies and follow-up may represent opportunities for quality improvement.