Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, UNC-CH, Chapel Hill, NC, 27599-7080, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
Dig Dis Sci. 2024 Oct;69(10):3844-3852. doi: 10.1007/s10620-024-08590-8. Epub 2024 Aug 13.
Despite recommendations to perform esophageal biopsies during esophagogastroduodenoscopy (EGD) for esophageal food impaction to evaluate for eosinophilic esophagitis (EoE), endoscopists often forgo biopsies. There are minimal data on the risks of biopsies in this setting.
To determine the safety of performing biopsies during EGD for food impaction.
We conducted a retrospective cohort study of patients who presented to University of North Carolina Hospitals from 2014 to 2021 with endoscopically confirmed food impaction. Data were abstracted from the medical records. Baseline clinical characteristics, procedural details, and adverse events were compared between patients who did and did not undergo biopsy. Adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extra-esophageal (aspiration, respiratory compromise, hypotension, arrhythmia).
Of 188 patients who underwent EGD for food impaction, 73 (39%) had biopsies taken. Older and non-White patients were less likely to be biopsied. None of the Black patients had biopsies taken. Only 2 (2.7%) of the 73 biopsied patients had an adverse event, and neither was related to the biopsies. Patients who were biopsied were less likely to experience adverse events. There were no differences in re-admission, ICU admission, or 30-day mortality between patients who were and were not biopsied.
Esophageal biopsies remain underperformed during EGD for food impaction, especially in certain patient populations. Esophageal biopsies at the time of food impaction are unlikely to cause adverse events. Safety concerns should not preclude biopsies, and biopsies should be performed in the absence of extenuating circumstances.
尽管有建议在食管胃十二指肠镜检查（EGD）中对食管食物嵌塞进行食管活检以评估嗜酸性食管炎（EoE），但内镜医生经常避免进行活检。在这种情况下，关于活检风险的数据很少。
确定在 EGD 中对食物嵌塞进行活检的安全性。
我们对 2014 年至 2021 年期间在北卡罗来纳大学医院就诊并经内镜证实为食物嵌塞的患者进行了回顾性队列研究。从病历中提取数据。比较了进行和未进行活检的患者之间的基线临床特征、程序细节和不良事件。不良事件分为食管（黏膜撕裂、出血、穿孔）或食管外（吸入、呼吸窘迫、低血压、心律失常）。
在 188 例因食物嵌塞而行 EGD 的患者中，73 例（39%）进行了活检。年龄较大和非白人患者进行活检的可能性较小。黑人患者无一例进行活检。在 73 例接受活检的患者中，只有 2 例（2.7%）发生了不良事件，且均与活检无关。进行活检的患者发生不良事件的可能性较低。接受活检和未接受活检的患者之间在再入院、入住 ICU 和 30 天死亡率方面没有差异。
在 EGD 中对食物嵌塞进行活检仍然做得不够，尤其是在某些患者人群中。在食物嵌塞时进行食管活检不太可能引起不良事件。安全问题不应排除活检，在没有特殊情况下应进行活检。
