TBA (25S135)

Los Angeles Grade C and D Oesophagitis: Re-evaluation over Two Decades at an Irish Tertiary Referral Centre

Author(s)

TJ Matthews, C Barry, R Wilson, G Bennett, B Kelleher, C Lahiff, J Leyden, N Ramlaul, S Stewart, O Craig

Department(s)/Institutions

Department of Gastroenterology, The Mater Hospital, Dublin

Introduction

British Society of Gastroenterology, European Society of Gastrointestinal Endoscopy and Health Service Executive guidelines suggest interval re-evaluation of LA Grade C and D oesophagitis to identify occult malignancy.

Aims/Background

We aimed to evaluate our service’s re-evaluation of oesophagitis, identify factors which predict malignancy and determine our yield of surveillance.

Method

We queried and cross-referenced our endoscopy and histology databases. Data analysis was conducted in Microsoft Excel and R.

Results

1,700 index case of LA Grade C/D oesophagitis were identified over 18.5 years ended November-2023. 62% were male and the median age was 62 (IQR:48-74). The number of index cases per year was static over time (R2=0.01). 717 had a first re-evaluation (42%). 22% (n=155) were persistent and a further 106 re-evaluations were performed. 6 cases were subsequently diagnosed with an oesophageal malignancy. Median age was 77.5 (IQR:50-84.5) and 50% were male. A probit logistic regression identified age (≥80 years) as a predictor (OR: 1.83, 95%CIs:1.04-3.20, p=0.04) whereas gender was not (p=0.55). Index histology was obtained in each case of malignancy. 3 of these malignancies (50%) were diagnosed on index histology. Of the remaining 3, 1 was diagnosed on a repeat 66-days later. The remaining 2 had a non-revelatory re-evaluation an average of 12.7 weeks later, and were subsequently diagnosed an average of 2.2 years later.

Conclusions

Our yield of LA Grade C and D oesophagitis re-evaluation over almost two decades was low despite the performance of 823 surveillance procedures at an approximate inflation-adjusted expenditure of €580,215.