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Tu1030 Geographic Variability in Management of Esophageal Food Impactions
Abstracts
may be necessary to prevent in-hospital death and reduce length of stay have not been identified.
than GI non-US performed the EGD in the ER (28% vs 5%; p<0.01). While only a small proportion of GIs used pharmacologic and non-pharmacological approaches, a significantly lower proportion of GI US compared to GI non-US used calcium channel blockers (1% vs 15%; p<0.01) and effervescence (2% vs. 12%; p<0.01). The average time from ER to EGD was significantly shorter in GI US compared to non GI US [mean (SD): 4.9 (3.6) vs. 6.7 (5.3) hours; p<0.01). The GI US more frequently used a net to retrieve impacted food bolus compared to GI non-US (84% vs. 63%; p<0.01). A higher proportion of GI US were in private practice (30% vs. 10%; pZ0.01), were adult GIs (46% vs. 22%; p<0.01), and had been practicing over a longer period [16 (11) vs. 12 (12) years; pZ0.01] compared to GI US. After adjusting for the type of practice, age group of patients cared for and duration of practice, multivariate regression analysis revealed that involvement of ENTs, performing EFI removal in the ER, use of calcium channel blockers and effervescence, and the use of net to relieve EFI independently predicted the differences between GI US and GI non-US. Conclusions: Among members of US-based GI societies, substantial variability was observed in the management of EFI between GI US and GI non-US. However, a small and convenience[SG1] GI non-US sample limits the generalizability of our findings.
Table. Summary of EFI management patterns in GI US and GI non-US ENT specialty [n (%)] Esophagogram [n (%)] Upper GI [n (%)] Calcium channel blockers [n (%)] Effervescence [n (%)] EFI removal in ER [n (%)] Time to EGD (Hours) [Mean (SD)] Use of net [n (%)] Pediatric [n (%)] Adult [n (%)] Private practice [n (%)]
GI US (NZ261) 39 (15) 50 (19) 8 (3) 2 (1) 5 (2) 73 (28) 4.9 (3.6) 218 (84) 141 (54) 120 (46) 70 (30)
GI Non US (NZ41) 12 (29) 15 (37) 5 (12) 6 (15) 5 (12) 2 (5) 6.7 (5.3) 26 (63) 32 (78) 9 (22) 4 (10)
P value 0.023 0.012 0.007 0.000 0.001 0.000 0.006 0.002 0.003 0.003 0.019
Tu1031 Day Case âVeTreat and Transfer’ ERCP Service Under General Anaesthesia Yasser El-sherif*1, John Hunt1, Abid Suddle1, Brian Prater2, David Reffitt1, John Devlin1, Phillip Harrison1, Deepak Joshi1 1 Institute of Liver Studies, King’s College Hospital, London, United Kingdom; 2Department of Anaesthetics, King’s College Hospital, London, United Kingdom
Tu1030 Geographic Variability in Management of Esophageal Food Impactions Girish S. Hiremath*1, Sari Acra1, Sandeep K. Gupta2, Michael F. Vaezi1, Evan S. Dellon3 1 Vanderbilt University Medical Center, Nashville, TN; 2University of Illinois, Peoria, IL; 3University of North Carolina, Chapel Hill, NC Introduction: Esophageal food impaction (EFI) is a common emergency managed by gastroenterologists (GIs) worldwide. However, the geographic variability in management of EFI has not been studied. Aim: To understand EFI management patterns among GIs practicing in US (GI US) compared to those practicing outside US (GI non-US). Methods: In an online survey of GIs associated with the AGA, ACG, and NASPGHAN, we assessed resource availability (e.g., availability of Surgery, ENT services), resource utilization (e.g., radiology tests, location of EFI removal, time to EGD), clinical decision-making (e.g., pharmacologic and non-pharmacologic interventions, removal devices utilized), and demographics (e.g., practice setting, duration of practice, and pediatric vs adult specialty). Descriptive statistics were used to summarize the findings, and multivariate regression was used to identify independent predictors of practice patterns among GI US and GI non-US. Results: In all 302 complete responses were analyzed, of which 261 (86%) were from GI US and 41 (14%) were from GI non-US (see Table). Compared to GI US, a significantly higher proportion of GI non-US reported that ENTs (15% vs. 29%; pZ0.02) were involved in EFI management, and they ordered esophagograms (19% vs. 37%; pZ0.01) and upper GI series (3% vs 12%; p<0.01) more frequently. A higher proportion of GI US
www.giejournal.org
Background: General Anaesthesia (GA) has been increasingly used for advanced endoscopic procedures in particular ERCP (endoscopic retrograde cholangio-pancreatography). Given the increasing pressure on many hospitals, the delivery of such service on a regular basis may not always be possible. We established a new day case “treat and transfer GA ERCP” service at Kings College Hospital (KCH), NHS Foundation Trust, London, UK. The new service allows local hospitals to transfer inpatients requiring urgent GA ERCP to KCH endoscopy unit for a day case GA ERCP procedure. Patients are discharged back to their referring hospitals after four hours observation period post completion of ERCP. We describe our experience in evaluating the safety and overall feasibility of this new service. Method: Database has been prospectively interrogated for all adult inpatients who were referred to KCH endoscopy unit for urgent ERCP under GA during the period from March 2015 to July 2016. We documented patients’ demographics, ERCP indications, American Society of Anaesthetists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Results: 61 patients were referred to endoscopy unit at KCH for urgent day case GA ERCP from nine referring hospitals. The main indications were failed ERCP under conscious sedation 46% (28/61), and unavailability of GA ERCP list locally 43% (26/61). 3 patients were cancelled by their local hospitals (2 patients were unstable for transfer and 1 patient required full inpatient transfer to KCH liver ITU due to progressive deterioration). After exclusion of cancelled referrals, a total of 58 ERCPs patients were transferred to KCH endoscopy unit; 64% (37/58) females with median age 57 years (range 23-90). 76% (44/58) of patients had a virgin papilla, with 39% (23/58) of patients were ASA 3 or greater. The Cotton Grade was 3 or more in 50% (29/58) of patients. ERCP was performed on all patients and completed successfully in 86% (50/58). For patients with previous failed ERCP, repeat ERCP under GA was successful in 71% (20/28). ERCP was not completed in 8 patients (anatomical distortionZ5 and failed cannulationZ3). All patients were safely discharged back to their referring hospitals after the short observation period post-ERCP. No complications related to anaesthesia or endoscopy were reported peri- or post- procedure. Conclusions: Urgent inpatient transfers between hospitals for performing ERCP under GA as a day case is safe and feasible. The new GA ERCP pathway can be replicated by other UK centres.
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB547
may be necessary to prevent in-hospital death and reduce length of stay have not been identified.
than GI non-US performed the EGD in the ER (28% vs 5%; p<0.01). While only a small proportion of GIs used pharmacologic and non-pharmacological approaches, a significantly lower proportion of GI US compared to GI non-US used calcium channel blockers (1% vs 15%; p<0.01) and effervescence (2% vs. 12%; p<0.01). The average time from ER to EGD was significantly shorter in GI US compared to non GI US [mean (SD): 4.9 (3.6) vs. 6.7 (5.3) hours; p<0.01). The GI US more frequently used a net to retrieve impacted food bolus compared to GI non-US (84% vs. 63%; p<0.01). A higher proportion of GI US were in private practice (30% vs. 10%; pZ0.01), were adult GIs (46% vs. 22%; p<0.01), and had been practicing over a longer period [16 (11) vs. 12 (12) years; pZ0.01] compared to GI US. After adjusting for the type of practice, age group of patients cared for and duration of practice, multivariate regression analysis revealed that involvement of ENTs, performing EFI removal in the ER, use of calcium channel blockers and effervescence, and the use of net to relieve EFI independently predicted the differences between GI US and GI non-US. Conclusions: Among members of US-based GI societies, substantial variability was observed in the management of EFI between GI US and GI non-US. However, a small and convenience[SG1] GI non-US sample limits the generalizability of our findings.
Table. Summary of EFI management patterns in GI US and GI non-US ENT specialty [n (%)] Esophagogram [n (%)] Upper GI [n (%)] Calcium channel blockers [n (%)] Effervescence [n (%)] EFI removal in ER [n (%)] Time to EGD (Hours) [Mean (SD)] Use of net [n (%)] Pediatric [n (%)] Adult [n (%)] Private practice [n (%)]
GI US (NZ261) 39 (15) 50 (19) 8 (3) 2 (1) 5 (2) 73 (28) 4.9 (3.6) 218 (84) 141 (54) 120 (46) 70 (30)
GI Non US (NZ41) 12 (29) 15 (37) 5 (12) 6 (15) 5 (12) 2 (5) 6.7 (5.3) 26 (63) 32 (78) 9 (22) 4 (10)
P value 0.023 0.012 0.007 0.000 0.001 0.000 0.006 0.002 0.003 0.003 0.019
Tu1031 Day Case âVeTreat and Transfer’ ERCP Service Under General Anaesthesia Yasser El-sherif*1, John Hunt1, Abid Suddle1, Brian Prater2, David Reffitt1, John Devlin1, Phillip Harrison1, Deepak Joshi1 1 Institute of Liver Studies, King’s College Hospital, London, United Kingdom; 2Department of Anaesthetics, King’s College Hospital, London, United Kingdom
Tu1030 Geographic Variability in Management of Esophageal Food Impactions Girish S. Hiremath*1, Sari Acra1, Sandeep K. Gupta2, Michael F. Vaezi1, Evan S. Dellon3 1 Vanderbilt University Medical Center, Nashville, TN; 2University of Illinois, Peoria, IL; 3University of North Carolina, Chapel Hill, NC Introduction: Esophageal food impaction (EFI) is a common emergency managed by gastroenterologists (GIs) worldwide. However, the geographic variability in management of EFI has not been studied. Aim: To understand EFI management patterns among GIs practicing in US (GI US) compared to those practicing outside US (GI non-US). Methods: In an online survey of GIs associated with the AGA, ACG, and NASPGHAN, we assessed resource availability (e.g., availability of Surgery, ENT services), resource utilization (e.g., radiology tests, location of EFI removal, time to EGD), clinical decision-making (e.g., pharmacologic and non-pharmacologic interventions, removal devices utilized), and demographics (e.g., practice setting, duration of practice, and pediatric vs adult specialty). Descriptive statistics were used to summarize the findings, and multivariate regression was used to identify independent predictors of practice patterns among GI US and GI non-US. Results: In all 302 complete responses were analyzed, of which 261 (86%) were from GI US and 41 (14%) were from GI non-US (see Table). Compared to GI US, a significantly higher proportion of GI non-US reported that ENTs (15% vs. 29%; pZ0.02) were involved in EFI management, and they ordered esophagograms (19% vs. 37%; pZ0.01) and upper GI series (3% vs 12%; p<0.01) more frequently. A higher proportion of GI US
www.giejournal.org
Background: General Anaesthesia (GA) has been increasingly used for advanced endoscopic procedures in particular ERCP (endoscopic retrograde cholangio-pancreatography). Given the increasing pressure on many hospitals, the delivery of such service on a regular basis may not always be possible. We established a new day case “treat and transfer GA ERCP” service at Kings College Hospital (KCH), NHS Foundation Trust, London, UK. The new service allows local hospitals to transfer inpatients requiring urgent GA ERCP to KCH endoscopy unit for a day case GA ERCP procedure. Patients are discharged back to their referring hospitals after four hours observation period post completion of ERCP. We describe our experience in evaluating the safety and overall feasibility of this new service. Method: Database has been prospectively interrogated for all adult inpatients who were referred to KCH endoscopy unit for urgent ERCP under GA during the period from March 2015 to July 2016. We documented patients’ demographics, ERCP indications, American Society of Anaesthetists (ASA) status, Cotton grade of endoscopic difficulty and endoscopic and anaesthetic complications. Results: 61 patients were referred to endoscopy unit at KCH for urgent day case GA ERCP from nine referring hospitals. The main indications were failed ERCP under conscious sedation 46% (28/61), and unavailability of GA ERCP list locally 43% (26/61). 3 patients were cancelled by their local hospitals (2 patients were unstable for transfer and 1 patient required full inpatient transfer to KCH liver ITU due to progressive deterioration). After exclusion of cancelled referrals, a total of 58 ERCPs patients were transferred to KCH endoscopy unit; 64% (37/58) females with median age 57 years (range 23-90). 76% (44/58) of patients had a virgin papilla, with 39% (23/58) of patients were ASA 3 or greater. The Cotton Grade was 3 or more in 50% (29/58) of patients. ERCP was performed on all patients and completed successfully in 86% (50/58). For patients with previous failed ERCP, repeat ERCP under GA was successful in 71% (20/28). ERCP was not completed in 8 patients (anatomical distortionZ5 and failed cannulationZ3). All patients were safely discharged back to their referring hospitals after the short observation period post-ERCP. No complications related to anaesthesia or endoscopy were reported peri- or post- procedure. Conclusions: Urgent inpatient transfers between hospitals for performing ERCP under GA as a day case is safe and feasible. The new GA ERCP pathway can be replicated by other UK centres.
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB547