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PWE-170 Management of dysphagia: variations in clinical pracrice
  1. A Rehman1,
  2. YC Lim2,
  3. Y Al-Naeeb3,
  4. B Javaid1
  1. 1Gastroenterology, Bedford Hospital, Bedford, UK
  2. 2University Hospital of North Durham, Durham
  3. 3Bedford Hospital, Bedford, UK

Abstract

Introduction Dysphagia is a common indication for upper gastrointestinal endoscopy. Dysphagia warrants an urgent referral for Oesophago-gastroduodenoscopy (OGD) under 2 week rule to exclude cancer in the United Kingdom (UK). In cases where no malignancy is identified, subsequent management may differ as there are no national guidelines. This survey evaluates current practice in management of dysphagia across the UK.

Method An online questionnaire was designed and sent to full and trainee members of British Society of Gastroenterology. The data was collated on an online platform and then downloaded to Microsoft Excel for evaluation.

Results A total of 906 questionnaires were e-mailed with a 14% (130) response rate. 72% (94) of the respondents were consultants and 28% (36) were trainees. 58% (74) of the these worked in University hospitals, 45% (57) in district general hospitals and 3% (4) in Primary care. Practice varied widely on patient review prior to initiating investigations (See Table 1). Oesophago-duodenoscopy (OGD) was the investigation of choice in 98%(128) response when sent straight for investigation Oesophageal biopsies were always taken by 15%(19), most of the time by 40% (52), sometimes 39% (51), rarely 5% (7), and never 1% (1). If OGD was normal 32% (41) will biopsy all three oesophageal segments, 24% (31) will take mid and lower oesophageal biopsies, 8% (10) will sample upper and lower oesophagus, 21% (27) will biopsy mid oesophagus only, 8% (11) will biopsy lower oesophagus only and 1% (1) will take no biopsies. If OGD was normal 51% (66) would request Barium swallow, 22% (29) would do manometry, 18% (24) would investigate by manometry with impedance studies, 5% (6)would consider other investigations and 4% (5) would not perform any further tests. For patients describing oro-pharyngeal (upper) dysphagia and normal OGD 42% (55) clinicians will review patient in clinic, 27% (35) will arrange further investigations, 17% (22) other strategies and 14% (18) will discharge the patient.

Abstract PWE-170 Table 1

Variation in clinic review prior to investigations and differences in oesophageal biopsies taken

Conclusion This survey shows that although 98% of clinicians will use OGD as the first line investigation there is wide variation in subsequent management if the OGD was normal. This highlights the need for nationally agreed guidelines across the UK to minimise variations in clinical practice.

Disclosure of interest None Declared.

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