Document resource
Introduction The Edinburgh Dysphagia Score (EDS) is a validated screening tool designed to identify malignancy risk in patients presenting with dysphagia. In 2020, the British Society of Gastroenterology recommended its use to risk stratify patients referred via the urgent dysphagia pathway, enabling prioritisation of those at highest risk of cancer during the COVID-19 period of limited endoscopy capacity. In the post pandemic era, incorporation of EDS into routine primary care triage may reduce unnecessary referrals to the urgent upper gastrointestinal (UGI) endoscopy pathway.Methods A single centre retrospective review of 171 patients referred with dysphagia from primary care via the urgent UGI endoscopy pathway between December 2022 and June 2023. EDS was retrospectively calculated for each patient; scores ≥3.5 were defined as high risk for malignancy. Diagnostic accuracy was evaluated against endoscopic and histological findings. The potential clinical impact of using EDS as a pre-referral triage tool was assessed by estimating the proportion of urgent referrals that could have been avoided.Results EDS ≥3.5 demonstrated 100% sensitivity, 34% specificity, positive predictive value (PPV) 9.4%, and negative predictive value (NPV) 100% for detecting UGI cancer. All patients with cancer had an EDS ≥3.5, while no cancers occurred in the EDS <3.5 group. Among non-cancer patients, 34% were correctly identified as low risk. The mean EDS for non-cancer patients was 4.6 (median 4.5; IQR 3.0–6.0), compared with 6.6 (median 6.0; IQR 5.75–8.0) in the cancer group. If EDS had been used to triage patients with scores <3.5 away from the urgent pathway to routine endoscopy, 32% of urgent referrals could have been avoided without missing any cancers ( figure 1: Distribution of the Edinburgh Dysphagia Score (EDS) in cancer versus non-cancer patients). Among individual EDS components, unintentional weight loss demonstrated the highest specificity (77%) and PPV (9.8%), while ‘age greater than 65’ showed the greatest sensitivity, with 73% of cancers occurring in this group.Conclusions EDS is a highly sensitive and safe pre-referral triage tool which can aid in prioritisation of patients presenting with dysphagia for investigation. Patients with an EDS of <3.5 could be stepped down to a routine endoscopy pathway. Implementation of EDS in primary care could safely reduce urgent UGI endoscopy referrals by approximately one-third, alleviating pathway pressures without compromising cancer detection.Abstract P346 Figure 1