Is EGD Reporting Adequate: A Review of Reports from 100 Referring Gastroenterologists

Joshua A Boys, MD, Beina Azadgoli, BS, Matthew Martinez, BS, Daniel S Oh, MD, Jeffrey A Hagen, MD, Steven R DeMeester. University of Southern California, Keck School of Medicine, Los Angeles, California

Introduction: Esophagogastroduodenoscopy (EGD) is commonly performed in patients with symptoms of gastroesophageal reflux disease (GERD).  A report that includes relevant landmarks and findings is important for communication with referring physicians and to document a patient’s baseline status. Pertinent findings include: the presence of esophagitis or a columnar lined esophagus (CLE), the locations of the squamocolumnar junction (SCJ), gastroesophageal junction (GEJ), and crural impression and the type of a hiatal hernia if present.  Our aim was to evaluate how commonly these pertinent findings were described in patients being evaluated for GERD.  

Methods: A retrospective review was performed of consecutive EGD reports in patients referred to our center from 2012-2015. To avoid multiple reports from a single endoscopist, we used only the first report encountered from an endoscopist. Reports were reviewed for a description of pertinent findings.

Results: We reviewed 100 EGD reports from different endoscopists in 100 individual patients.   Esophagitis was reported in 33 patients, but was graded only 14 (42%). The LA and Savory-Miller classifications were used equally. The esophagitis was characterized as erosive by 15% of endoscopists.    A CLE was documented in 28 patients, but the length was reported in only 16 (57%), and no report used the Prague classification system.  A hiatal hernia was present in 61 patients, but it was measured by only 31 (51%). In the remainder it was subjectively described.  The type of hiatal hernia, sliding versus paraesophageal, was classified in only 26% of patients.  One or more biopsies were taken in 93 patients.  Biopsies were taken from the stomach alone in 19, esophagus/GEJ in 20 and both locations in 48 patients.  The location of the biopsy was not documented in 7% of patients. In 12 patients undergoing surveillance for known Barrett’s esophagus, a Seattle biopsy protocol was used in only 1 patient. 

Conclusion: Grading systems for esophagitis or a CLE when present were reported by only 28% of endoscopists. The size and type of hiatal hernia were reported by only 13 % of endoscopists.  Routine use of an established grading system, measurement of a hiatal hernia size and a description of the type of hernia would be beneficial to improve communication between endoscopists and other physicians. Further, these descriptions are invaluable to allow assessment of treatment response or disease progression in a patient.