P3235 - Role of Esophagogastroduodenoscopy in Evaluation of Progressive Neuromuscular Dysphagia

R. Christopher Chase, MD¹, Pedro Cortes, MD¹, Christopher J.. Lamb, MD², Dawn Francis, MD², Kenneth DeVault, MD², Maoyin Pang, MD, PhD^2
1Mayo School of Graduate Medical Education, Jacksonville, FL; ²Mayo Clinic Florida, Jacksonville, FL

Introduction: Patients with progressive neuromuscular disorders (NMD) commonly develop dysphagia, warranting an early need to establish the best approach in management. Despite many available diagnostic instruments, there remains little consensus on the role of initial esophagogastroduodenoscopy (EGD) in the setting of NMD. We aimed to better characterize predictors associated with the recommendation of EGD at initial gastroenterology (GI) consultation of patients who were referred for dysphagia secondary to progressive NMD.

Methods: Our retrospective study across four tertiary academic centers evaluated patients with both dysphagia and NMD and who were sent for EGD between December 2010 and December 2021. NMD included amyotrophic lateral sclerosis (ALS), myasthenia gravis, hereditary myopathy, critical illness myopathy, inflammatory myopathy, inclusion body myositis, and multiple sclerosis. Clinical severity was gauged by validated indices including the Charlson Comorbidity Index, the Clinical Fragility Scale (CFS), and the American Association of Anesthesiology (ASA) classification. Multivariate logistic regression determined predictors for EGD recommendation after initial visit.

Results: Of 273 patients included (median age 63.9, male 42.6%), EGD was recommended for 163 (58.7%). Using multivariable logistic regression adjusting for male sex, age, and clinical frailty scale, ALS diagnosis (OR 0.20, 95% CI: 0.07-0.52, p=0.0011) and Neurology referral source (OR 0.37, 95% CI: 0.17-0.84, p=0.0177) were predictive of no initial EGD recommendation. ALS diagnosis was associated with gastrostomy placement (HR 10.39, 95% CI: 5.34-20.19, p< 0.0001). Table 1. A model of six variables including age, sex, clinical frailty scale, diagnosis of ALS, duration of disease, and Neurology referral source, formed a predictive model EGD recommendation after initial GI consultation with AUC: 0.7741. Figure 1.

Discussion: We found that an ALS diagnosis and referral to GI by a neurologist were predictive of no EGD recommendation after initial consultation. Patients diagnosed with ALS that had been referred by a neurologist may have had more clinical certainty of the diagnosis and therefore need for gastrostomy placement rather than EGD. This study also creates a predictive model for initial EGD recommendation. With exception of sex, the 6 predictor variables corresponded to either increasing disease severity or increased disease duration.



Disclosures:


R. Christopher Chase, MD¹, Pedro Cortes, MD¹, Christopher J.. Lamb, MD², Dawn Francis, MD², Kenneth DeVault, MD², Maoyin Pang, MD, PhD². P3235 - Role of Esophagogastroduodenoscopy in Evaluation of Progressive Neuromuscular Dysphagia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.