Utility of Upper Endoscopy as a Diagnostic Tool in Symptomatic Patients With Gastroparesis: A Retrospective Study: 2464

Introduction: Gastroparesis is a condition characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. Gastric emptying scintigraphy (GES) is the gold standard for diagnosis of gastroparesis. Structural evaluation with esophagogastroduodenoscopy (EGD) or radiographic study is required to exclude mechanical obstruction prior to establishing a diagnosis of gastroparesis. We conducted a retrospective study to evaluate the utility of EGD in the diagnosis of gastroparesis in a subset of patients with residual food matter in the stomach at the time of endoscopy. Methods: A retrospective study at a single tertiary-care center was performed after IRB approval. All adult patients that underwent GES at our hospital from January 2013 through August 2014 were included. Patient charts were reviewed for the following data: Age, gender, procedure indications, GES results and EGD findings. We included patients with delayed gastric emptying documented by abnormal GE study that underwent EGD. Exclusion criteria included age < 18 years, normal GES results, no prior EGD, mechanical gastric outlet obstruction, patients who were not NPO for at least 6 hours prior to EGD, and pregnant patients. Statistical analysis was performed using descriptive statistics and calculations based on true/false positives and negatives. Results: A total of 483 patients were identified who underwent GES and EGD during the study period. Of these, 56 patients had retained food during EGD. Of these, 32 patients had abnormal GES confirming gastroparesis and 24 patients had normal GES excluding gastroparesis. The specificity of EGD for diagnosis of gastroparesis in patients with retained food was 90%. 426 patients had no residual food during EGD. Of these, 209 patients had abnormal GES and 216 patients had normal GES. In this subset population (no retained food), the calculated sensitivity of EGD for gastroparesis was 13.3%, PPV was 57.1% and NPV was 50.8%. Conclusion: The specificity of EGD in diagnosis of gastroparesis is high (90%) in patients with findings of retained food matter during endoscopy. This subset of patients with gastroparesis may not require GES.