S499 Prevalence of Dabigatran-Induced Esophagitis on Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis

Abstract

Introduction: Dabigatran-induced esophagitis (DIE) has been reported increasingly recently in the literature. However, the exact prevalence of DIE is uncertain. Therefore, we performed a systematic review and meta-analysis to define and provide a quantitative assessment of the prevalence of DIE on endoscopy. Methods: A comprehensive literature search of PubMed/Medline, Embase, and Web of Science was conducted on April 01, 2022, to include all studies that reported the prevalence of DIE among patients undergoing upper endoscopy. Two independent reviewers (AB and RM) screened and shortlisted articles and performed data extraction. Any discrepancy was resolved by consensus. The statistical analysis was performed using Open Meta Analyst (CEBM, Oxford, UK). Pooled event rate and corresponding 95% confidence intervals (CI) were calculated using the random-effects model and DerSimonian Laird method. Heterogeneity was assessed using the Higgins I2 index (I2 values >50% implied the presence of significant heterogeneity). Results: Five retrospective cohort studies with 339 patients were included. All studies originated from Japan. The pooled prevalence rate of DIE was 15.5% (95% CI 0.096-0.239, I2=62.4%, Figure A). A leave-one-out sensitivity analysis showed similar results (Figure B). Four studies reported the detailed endoscopic features of DIE. All DIE occurred in the mid and/or lower esophagus. Longitudinal mucosal casts were the most common endoscopic feature, with a pooled rate of 82.2% (95% CI 0.254-0.984, I2=74.8%, Figure C). The pooled rate of mucosal erosions was 20.5% (95% CI 0.025-0.725, I2=72.5%, Figure D). Conclusion: Nearly 15% of patients receiving dabigatran were found to have dabigatran-induced esophagitis on endoscopy. Physicians should be cautious about using dabigatran in patients with a history of esophagitis or gastroesophageal reflux disease. Patients who receive dabigatran should undergo an upper endoscopy to evaluate for DIE if they develop gastrointestinal symptoms. Prospective, large-scale, multicenter studies are needed to further understand DIE.Figure 1.: (A) forest plot showing the pooled overall prevalence of dabigatran-induced esophagitis. (B) Leave-one-out sensitivity analysis for prevalence of dabigatran-induced esophagitis. Forest plots showing the pooled rate of (C) longitudinal mucosal casts and (D) erosions in dabigatran-induced esophagitis.