No increase of biopsy rates despite high rates of probable eosinophilic esophagitis in patients with esophageal food impaction.

Introduction: Eosinophilic esophagitis (EoE) is one of the main causes of esophageal food impaction (EFI). Since only few endoscopists take biopsies during the emergency endoscopy at EFI presentation, as is recommended by current guidelines, a high number of patients will not have a proper diagnosis after EFI. Hence, we investigated the change of biopsy rates and the etiology of EFI over 11 years.

Methods: All patients presenting at the emergency department (ED) of a tertiary center with an EFI who underwent esophagogastroduodenoscopy (EGD) between 2013 and 2023 were included. Clinical and endoscopic variables were analyzed retrospectively. We performed a binary logistic regression model to predict biopsy performance.

Results: A total of 180 EFI cases (67% male, median age 57 years) were recorded between 2013 and 2023. Overall, esophageal biopsies were taken only in 18% without any increase over time. In patients ≥ 50 years of age (n = 108), the etiology remained unknown in half of patients (48%), followed by gastroesophageal reflux disease (GERD; 23%) and EoE (18%). However, in patients < 50 years of age, EoE was the main suspected etiology in 69% of cases. Biopsies were obtained in only 18% of all patients with suspected EoE. Age, gender, and the year of EFI were not associated with biopsy performance. However, the probability of biopsy increased by a factor of 4.03 in the presence of suspected EoE by the endoscopist.

Conclusion: Despite an increasing awareness of EoE, the biopsy rate in EFI is rather low. Routine biopsies should be taken to shorten diagnostic delay.