Utility of a follow-up endoscopy after a diagnosis of severe oesophagitis or oesophageal ulcer and predictors of cancer and dysplasia

Objective Follow-up oesophago-gastroduodenoscopy (OGD) is recommended after diagnosing oesophageal ulcer or severe oesophagitis. We aimed to examine the yield of a follow-up OGD to identify oesophageal cancer or dysplasia and their predictors. Method In this retrospective cohort study, we collected demographic, endoscopy, histology and follow-up data from 771 patients diagnosed with oesophageal ulcer or severe oesophagitis. We examined the proportion of patients diagnosed with cancer or dysplasia at follow-up. Cost and carbon footprint of follow-up OGDs were estimated. Results The yield of cancer at follow-up was 0.40% and the yield of cancer or dysplasia 0.81%. Those who were diagnosed with oesophageal cancer or dysplasia, compared with those who were not, were older (mean age 71.9 (SD 9.9) vs 64.9 (SD 16.7), p<0.001), more likely to have ulcers ≥10 mm (68.2% vs 3.0% p<0.001), endoscopic features suspicious for malignancy (62.2% vs 4.6%, p<0.001), Barrett’s oesophagus (54.1% vs 10.2%, p<0.001) and have biopsies taken at index OGD (97.3% vs 52.5%, p<0.001). Following logistic regression, those with endoscopic features of cancer (OR=27.8; 95% CI 7.74 to 99.6) and those with associated Barrett’s oesophagus identified at the index OGD (OR=7.91; 95% CI 2.44 to 25.6) were more likely to be diagnosed with cancer or dysplasia. Estimated cost for follow-up OGDs was £356 850 and the estimated carbon footprint was 21 056 kg of CO 2 equivalent. Conclusion The yield of cancer or dysplasia at follow-up is low, suggesting that current guideline recommendations should be reconsidered.