Food Residue During Esophagogastroduodenoscopy Is Commonly Encountered and Is Not Pathognomonic of Delayed Gastric Empty
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ORIGINAL ARTICLE
Food Residue During Esophagogastroduodenoscopy Is Commonly Encountered and Is Not Pathognomonic of Delayed Gastric Emptying Danse Bi1 · Chansong Choi1 · John League2 · Michael Camilleri2,3 · David O. Prichard2 Received: 26 August 2020 / Accepted: 12 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and Aims Retained gastric food (RGF) identified during esophagogastroduodenoscopy (EGD) is often attributed to gastroparesis. This retrospective study evaluated the prevalence of RGF, risk factors for RGF, and the association between RGF and delayed gastric emptying (GE). Methods The prevalence and odds ratios for RGF in patients with structural foregut abnormalities or medical risk factors for delayed GE were determined from 85,116 EGDs performed between 2012 and 2018. The associations between RGF, delayed GE, and medical comorbidities were evaluated in 2991 patients without structural abnormalities who had undergone EGD and gastric emptying scintigraphy. The relationship between medication use and RGF was evaluated in 249 patients without structural or medical risk factors for RGF. Results RGF was identified during 3% of EGDs. The odds of RGF were increased in patients with type 1 diabetes (12%, OR 1.7, P ≤ 0.001), type 2 diabetes (6%, OR 1.4, P ≤ 0.001), gastroparesis (14%, OR 4.8, P ≤ 0.001), amyloidosis (5%, OR 1.7, P ≤ 0.001), and structural foregut abnormalities (6%, OR 2.6, P ≤ 0.001). Overall, the PPV of RGF for delayed GE was 55%. However, the PPV varied from 32% in patients without risk factors to 79% in patients with type 1 diabetes. Opioids, cardiovascular medications, and acid suppressants were associated with RGF. Conclusions RGF is common during EGD. The PPV of RGF for delayed GE varies depending on underlying risk factors (type 1 diabetes, type 2 diabetes, gastroparesis, and amyloidosis). Acid suppressants or antacids, cardiovascular medications, and opioids are associated with RGF independent of delayed GE. Keywords Esophagogastroduodenoscopy · Bezoar · Retained gastric food · Gastric emptying · Gastroparesis Abbreviations EGD Esophagogastroduodenoscopy GE Gastric emptying GES Gastric emptying scintigraphy OR Odds ratio NPV Negative predictive value Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06718-0) contains supplementary material, which is available to authorized users. * David O. Prichard [email protected] 1
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
2
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
3
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA
PPV Positive predictive value RGF Retained gastric food
Introduction More than 6 million upper gastrointestinal endoscopies were performed in the USA in 2018 [1]. The presence of food in the stomach during esophagogastroduodenoscopy (EGD) impairs mucosal visualizat
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