Daglilar Ebubekir, Connolly Sean E, Tahan Veysel, Cohen Ari, Therapondos George
Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, USA.
Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, USA.
Cureus. 2020 Nov 4;12(11):e11323. doi: 10.7759/cureus.11323.
Background Gastrointestinal (GI) symptoms impact quality of life and increase health care utilization after liver transplantation (LTx). Esophagogastroduodenoscopy (EGD) is commonly used to investigate these symptoms. Aims The aim of this study was to investigate the diagnostic yield and utilization of EGD after LTx for common GI symptoms. Methods This single-center retrospective cohort study was conducted at a large liver transplant center and included all adults who underwent EGD within the first year after receiving LTx between January 1, 2015, and December 31, 2016. Biliary procedures were excluded. Results Of 437 patients who underwent LTx during the study period, 64 (15%) underwent EGD for the evaluation of GI symptoms within the first year of transplantation. After applying exclusion criteria, 57 (13%) cases were analyzed. GI hemorrhage (hematemesis/melena) was the most common reason (4%; n=18) for evaluation with EGD followed by nausea/anorexia (3%; n=12). Symptoms were investigated with EGD, including epigastric/abdominal pain (2%; n=9), dysphagia/odynophagia (2%; n=8), anemia (1%; n=5), diarrhea (1%; n=4), and heartburn (0.2%; n=1). The diagnostic yield of EGD was highest with GI hemorrhage (83%) followed by dysphagia/odynophagia (75%). EGD diagnostic yield was lower for the other symptoms, ranging from 0% to 25%. Conclusions EGD was commonly utilized within the first year of LTx, with the highest diagnostic yields for GI hemorrhage and dysphagia/odynophagia. Because of the low diagnostic yield of EGD for other symptoms, we recommend a careful selection of patients for EGD following LTx.
背景 胃肠道（GI）症状会影响生活质量，并增加肝移植（LTx）后的医疗保健利用率。食管胃十二指肠镜检查（EGD）常用于调查这些症状。目的 本研究旨在调查肝移植后针对常见胃肠道症状进行EGD检查的诊断率及应用情况。方法 这项单中心回顾性队列研究在一家大型肝移植中心进行，纳入了2015年1月1日至2016年12月31日期间接受肝移植后第一年内接受EGD检查的所有成年人。排除胆道手术患者。结果 在研究期间接受肝移植的437例患者中，64例（15%）在移植后第一年内因评估胃肠道症状而接受了EGD检查。应用排除标准后，分析了57例（13%）病例。胃肠道出血（呕血/黑便）是进行EGD检查最常见的原因（4%；n = 18），其次是恶心/厌食（3%；n = 12）。接受EGD检查的症状包括上腹部/腹痛（2%；n = 9）、吞咽困难/吞咽痛（2%；n = 8）、贫血（1%；n = 5）、腹泻（1%；n = 4）和烧心（0.2%；n = 1）。EGD对胃肠道出血的诊断率最高（83%），其次是吞咽困难/吞咽痛（75%）。EGD对其他症状的诊断率较低，范围为0%至25%。结论 EGD在肝移植后第一年内被普遍应用，对胃肠道出血和吞咽困难/吞咽痛的诊断率最高。由于EGD对其他症状的诊断率较低，我们建议在肝移植后仔细选择进行EGD检查的患者。
