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Endoscopy II
PTU-221 Dysphagia in a DGH: is there histological correlation of the visual diagnosis?
  1. K Axe1,
  2. C Ch'ng1,
  3. J Nagaraj2
  1. 1Gastroenterology, Singleton Hospital, Swansea, UK
  2. 2Gastroenterology, Morriston Hospital, Swansea, UK

Abstract

Introduction Dysphagia is a clinically important indication of malignancy; as well as a symptom of Oesophagitis, Barrett's oesophagus (BO), and peptic strictures; all of which should be easily recognised at biopsy. Dysphagia in younger patients' may indicate Eosinophilic Oesophagitis (EO), which may only be visible on histology. The aim of this study was to review the demographics of patients undergoing endoscopy and if there was histological and visual correlation to help guide our investigation of dysphagia.

Methods A retrospective study including dysphagic patients attending endoscopy at Singleton or Morriston hospital between 1 January 2010 and 31 October 2011. Patients were reviewed to identify demographics, endoscopic findings and correlation between visual and histological diagnosis. Where biopsies were indicated in the endoscopy report results were cross matched with the histology results. Hiatus hernia was considered normal and unspecified mass was considered to represent a visual diagnosis of malignancy unless otherwise stated. Patients undergoing more than one procedure had each procedure entered as a separate data set.

Results 694 patients (334 male, 340 female), median age 67 (range 21–99), 77% patients over 50. Endoscopy was visually normal in 45%, the commonest visual abnormalities were Oesophagitis (18%) and malignancy (13%). 23% of patients had biopsies. Suspected malignancy or BO were most likely to have biopsies taken (65% and 64% respectively), 9% visually normal endoscopies were biopsied. 83% (49 cases) with suspected malignancy had histological correlation, 17% (11 cases) had BO or Oesophagitis. Three patients were found to have malignancy where the visual diagnosis had been Oesophagitis or benign stricture. Both BO and Oesophagitis had >80% correlation visually and histologically. Six cases of EO were found, all were visually normal. One suspected case was seen at endoscopy, this was histologically normal.

Conclusion There was generally good correlation between visual and endoscopic diagnosis, particularly in malignancy, however biopsy number was lower than expected. Failure to biopsy may lead to missed diagnosis of cancer or dysplasia. All cases of EO in adults had normal endoscopy, few patients with dysphagia and normal endoscopy had biopsies taken. EO may be commoner than suspected, true rates are unknown and a high index of suspicion is needed. We should carry out more endoscopies on younger patients with symptoms in keeping with EO and biopsy normal oesophagus in cases where this diagnosis is suspected.

Competing interests None declared.

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