S1262 Upper Endoscopic Evaluations Resulting From Abnormal Imaging Study of Upper GI Tract Display Poor Concordance

Introduction: Abdominal imaging modes like computed tomography (CT) scans are performed to evaluate patients (pts) with gastrointestinal (GI) symptoms. These modalities report abnormalities like gastric wall thickening etc. which invariably lead to esophagogastroduodenoscopy (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, body mass index (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%), and white 264 (48.2%) vs black 261 (47.6%). The mean BMI was 27.2 kg/cm2. Main CT findings included diffuse and 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%, and 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% and 1.6% pts whose both CT scan and EGD showed a mass and hiatal hernia respectively (concordant findings). Focal thickening and 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 and 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% and 6.7% pts showing esophageal and 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% and 2.0% had a mass and polyp in stomach respectively. 46.9% and 10.2% had an esophageal and duodenal abnormality respectively. Conclusion: 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.