Abstract
BackgroundGastrointestinal (GI) symptoms impact quality of life and increase health care utilization after liver transplantation (LTx). Esophagogastroduodenoscopy (EGD) is commonly used to investigate these symptoms.AimsThe aim of this study was to investigate the diagnostic yield and utilization of EGD after LTx for common GI symptoms.MethodsThis single-center retrospective cohort study was conducted at a large liver transplant center and included all adults who underwent EGD within the first year after receiving LTx between January 1, 2015, and December 31, 2016. Biliary procedures were excluded.ResultsOf 437 patients who underwent LTx during the study period, 64 (15%) underwent EGD for the evaluation of GI symptoms within the first year of transplantation. After applying exclusion criteria, 57 (13%) cases were analyzed. GI hemorrhage (hematemesis/melena) was the most common reason (4%; n=18) for evaluation with EGD followed by nausea/anorexia (3%; n=12). Symptoms were investigated with EGD, including epigastric/abdominal pain (2%; n=9), dysphagia/odynophagia (2%; n=8), anemia (1%; n=5), diarrhea (1%; n=4), and heartburn (0.2%; n=1). The diagnostic yield of EGD was highest with GI hemorrhage (83%) followed by dysphagia/odynophagia (75%). EGD diagnostic yield was lower for the other symptoms, ranging from 0% to 25%.ConclusionsEGD was commonly utilized within the first year of LTx, with the highest diagnostic yields for GI hemorrhage and dysphagia/odynophagia. Because of the low diagnostic yield of EGD for other symptoms, we recommend a careful selection of patients for EGD following LTx.
Highlights
Liver transplantation (LTx) is a life-saving surgery for patients with end-stage liver disease, hepatocellular carcinoma, and other metabolic diseases of the liver [1]
GI hemorrhage was the most common reason (4%; n=18) for evaluation with EGD followed by nausea/anorexia (3%; n=12)
The diagnostic yield of EGD was highest with GI hemorrhage (83%) followed by dysphagia/odynophagia (75%)
Summary
Liver transplantation (LTx) is a life-saving surgery for patients with end-stage liver disease, hepatocellular carcinoma, and other metabolic diseases of the liver [1]. The average age of transplant recipients has been increasing [4], and recipients often have several comorbidities including cardiac, pulmonary, renal, and gastrointestinal (GI) illnesses that can complicate postoperative recovery, decrease quality of life [5], and increase health care utilization [6]. Aside from biliary complications, GI symptoms include GI bleeding [8] and nausea/anorexia, which can lead to malnutrition [9] and prolonged postoperative recovery [10]. Gastrointestinal (GI) symptoms impact quality of life and increase health care utilization after liver transplantation (LTx).
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