Use of the clinical frailty scale to tailor follow-up endoscopy in severe oesophagitis

Introduction

In this study we aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in clinically frail patients (according to the Clinical Frailty Scale) with severe oesophagitis through evaluating, by Los Angeles (LA) grade, the yield of Barrett’s oesophagus (BO), cancer, dysplasia and strictures.

Methods

Patients in NHS Lothian with an index OGD (OGD1) diagnosis of LA grades C or D oesophagitis between 01/01/14–31/12/15 were identified. Univariate analysis identified factors associated with grade. Patients were stratified by frailty, mortality and a diagnosis of stricture, cancer, dysplasia and BO at OGD1 and at OGD2.

Results

In total 964 patients (median age 64 years, 54.6% male) were diagnosed with severe oesophagitis, 61.7% grade C and 38.3% grade D. OGD2s were performed in 39.7% (n=236) of patients with grade C oesophagitis and in 40.4% (n=149) with grade D. When stratified according to frailty, 16.4% of frail patients (23/140) underwent OGD2; at a median follow-up time of 76 months, 88.6% (124/140) of frail patients were deceased. Amongst non-frail patients at OGD2, with the exception of BO (p=0.010), no pathologies were more common in patients with grade D oesophagitis than in grade C oesophagitis.

Conclusions

OGD2s should be performed in patients with severe oesophagitis (both grades C and D) who are not clinically frail due to the reduced life expectancy and negligible clinical benefits amongst frail patients.