541 Endoscopic Evaluation of Radiological Distal Esophageal Thickening

Abstract

INTRODUCTION: The growth of diagnostic imaging in healthcare has led to an increase in incidental findings of “Distal Esophageal Thickening” (DET). This nonspecific finding frequently prompts a formal Esophagogastroduodenoscopy (EGD) for evaluation – many of which demonstrate benign conditions and less commonly, malignancy. There may be many unnecessary procedures being performed and a misuse of valuable resources. Thus, we aim to determine the incidence of EGDs primarily performed for DET found on imaging, and the actual endoscopic and histologic findings for these EGDs. METHODS: We performed a retrospective chart review of 905 EGDs performed from 2016-2018 at a single institution. Patient demographics, comorbidities, symptoms, imaging reports, procedure reports, and pathology reports were collected. Descriptive analysis was performed to determine the incidence of EGDs performed for imaging findings of DET, as well as their endoscopic and histological findings. RESULTS: Demographics for the EGDs are in Table 1. Out of 905 total endoscopies, 6.6% (n=60) were done specifically due to findings of DET on imaging within 6 months of the EGD. Table 2 conveys the endoscopic findings, and Table 3 shows the histologic findings for DET and non-DET EGDs. Of all the endoscopic findings for DET patients (n=76), 11 (14.5%) showed either masses or suspicion for Barrett's Esophagus. 15.8% (n=3) of histological specimens were diagnosed with cancer and 21.1% (n=4) with intestinal metaplasia. This is compared to 3.77% (n=6) of histological specimens of patients with non-DET EGDs which had cancer diagnosed, and 28.3% (n=45) with intestinal metaplasia or dysplasia. CONCLUSION: There is a remarkable number of upper endoscopies performed specifically for imaging findings of DET. The majority of these endoscopic histological findings are benign. However, there is indeed an increased incidence of cancer for endoscopies performed for DET, compared to endoscopies not performed for DET. Next steps include determining specific risk factors associated with metaplasia, dysplasia, or cancer in patients with DET in order to better understand who would most benefit from an upper endoscopy and who would not.