Table 3.
Sub-group analysis and practice patterns among participating gastroenterologists [N=428]
| Adult Gastroenterologists$ Adjusted odds ratio (95% CI) |
Practicing in US¥ Adjusted odds ratio (95% CI) |
Private practice€ Adjusted odds ratio (95% CI) |
|
|---|---|---|---|
| Resource availability | |||
| Sub-specialty services | |||
| ENT | 0.35 (0.16 – 0.77)¶ | 0.35 (0.16 – 0.74)¶ | 0.34 (0.14–0.84)¶ |
| Surgery | 0.02 (0.003 – 0.21)¶ | 0.59 (0.26 – 1.35) | 0.81 (0.35–1.88) |
| Radiology | 1.03 (0.56–1.88) | 0.48 (0.23–1.00) | 0.63 (0.32–1.23) |
| Support staff | |||
| Gastroenterology technician | 1.18 (0.69–2.02) | 4.57 (1.85–11.30)¶ | 2.48 (1.45–4.25)¶ |
| Endoscopy nurse | 1.3 (0.82–2.31) | 1.63 (0.81–3.31) | 2.59 (1.15–4.69)¶ |
| Resource utilization | |||
| Radiologic tests | |||
| Chest x-ray | 0.60 (0.36–1.01) | 1.35 (0.68–2.64) | 0.51 (0.30–0.87)¶ |
| Esophagogram | 0.11 (0.04–0.27)¶ | 0.38 (0.18–0.82)¶ | 0.78 (0.38–1.63) |
| Upper Gastrointestinal (GI) series | 0.38 (0.07–1.84) | 0.29 (0.08–0.99)¶ | 0.66 (0.13–3.19) |
| CT scan | 3.5 (0.33–37.41) | 0.09 (0.01–0.75)¶ | 3.13 (0.47–20.86) |
| Location of EFI removal | |||
| Emergency Room | 87.96 (25.43–304.16)¶ | 5.24 (1.42–19.33)¶ | 0.70 (0.36–1.34) |
| Gastroenterology I lab | 2.43 (1.43–4.13)¶ | 1.12 (0.57–2.19) | 1.15 (0.62–2.89) |
| Operating Room | 0.17 (0.09–0.30)¶ | 2.40 (1.16–4.98)¶ | 0.39 (0.22–0.69)¶ |
| Clinical decision making | |||
| Pharmacologic and non-pharmacologic interventions | |||
| Peripherally acting agents | 0.87 (0.06–11.50) | 0.02 (0.01–0.30)¶ | 0.96 (0.12–7.23) |
| Smooth muscle relaxants | 7.77 (4.38–13.77)¶ | 1.57 (0.76–3.23) | 0.79 (0.45–1.38) |
| Benzodiazepines | 6.70 (1.36–33.13)¶ | 0.54 (0.13–2.28) | 1.58 (0.53–4.72) |
| Calcium channel blockers | 0.35 (0.03–3.46) | 0.02 (0.01–0.13)¶ | 1.85 (0.38–8.89) |
| Nitrates | 12.44 (1.44–106.95)¶ | 0.18 (0.04–0.86)¶ | 1.37 (0.38–4.89) |
| Gravity | 0.75 (0.32–1.76) | 0.39 (0.16–0.97)¶ | 1.46 (0.63–3.66) |
| Effervescence | 0.62 (0.10–3.68) | 0.12 (0.03–0.44)¶ | 0.12 (0.03–0.44)¶ |
| Time from presentation to ER to start of upper endoscopy (EGD) (Hours)# | 0.96 (0.90–1.03) | 0.90 (0.84–0.97)¶ | 0.92 (0.85–1.00) |
| Anesthesia | |||
| General anesthesia with intubation | 0.02 (0.009–0.06)¶ | 3.35 (1.35–8.31)¶ | 0.33 (0.18–0.62)¶ |
| Monitored anesthesia without intubation | 7.10 (3.57–14.09)¶ | 0.60 (0.26–1.37) | 1.70 (0.94–3.07) |
| Conscious sedation | 54.23 (17.42–168.82)¶ | 1.14 (0.43–2.99) | 0.98 (0.52–1.84) |
| Esophageal Food bolus disimpaction technique | |||
| Retrieve | 0.35 (0.17–0.74)¶ | 1.06 (0.41–2.73) | 1.03 (0.51–2.09) |
| Push | 5.58 (3.08–10.12)¶ | 0.97 (0.47–2.00) | 1.60 (0.87–2.92) |
| Both | 3.57 (2.30–5.56)¶ | 1.61 (0.37–6.95) | 1.00 (0.52–1.91) |
| Esophageal Food Impaction (EFI) removal devices | |||
| Snare | 1.41 (0.84–2.36) | 1.14 (0.58–2.22) | 1.88 (1.10–3.23)¶ |
| Forceps | 0.71 (0.43–1.18) | 0.94 (0.48–1.83) | 0.97 (0.57–1.62) |
| Net | 2.53 (1.23–5.22)¶ | 3.27 (1.56–6.83)¶ | 0.37 (0.19–0.71) |
| Graspers | 0.79 (0.47–1.32) | 1.70 (0.87–3.33) | 0.72 (0.42–1.22) |
| Baskets | 0.32 (0.18–0.56)¶ | 0.41 (0.20–0.83) | 1.29 (0.74–2.24) |
| Suction cup | 0.37 (0.20–0.67)¶ | 4.33 (1.61–16.11)¶ | 0.59 (0.32–1.08) |
| Biopsy practice | |||
| Yes, always obtain esophageal biopsies irrespective of endoscopic findings | Ref | Ref | Ref |
| Only if I observe abnormal endoscopic findings | 0.11 (0.05–0.23)¶ | 0.74 (0.31–1.78) | 0.80 (0.41–1.53) |
| No, I do not obtain biopsies | 3.49 (l.12–10.84)¶ | 4.20 (0.50–35.25) | 0.45 (0.18–1.09) |
| Number of biopsies | 0.93 (0.85–1.02) | 0.91 (0.80–1.03) | 1.03 (0.94–1.13) |
| Post EFI removal | |||
| Wait for biopsy results without starting any medications | Ref | Ref | Ref |
| Start medications irrespective of how the esophagus looks on endoscopy | 2.87 (1.42–5.78)¶ | 2.38 (0.88–6.43) | 0.74 (0.38–1.43) |
| Start medications only if the esophagus looks abnormal on endoscopy | 0.44 (0.23–0.84)¶ | 1.68 (0.77–3.66) | 0.40 (0.20–0.80)¶ |
| Dilation during EFI removal | 0.77 (0.46–1.27) | 0.72 (0.37–1.41) | 0.94 (0.56–1.58) |
| Post-EFI removal immediate therapeutic management | |||
| Carafate | 0.62 (0.28–1.37) | 1.03 (0.36–2.88) | 0.97 (0.43–2.17) |
| Proton-pump inhibitor (PPI) therapy – Regular dose | 1.27 (0.77–2.11) | 0.97 (0.50–1.89) | 1.39 (0.82–2.34) |
| PPI therapy - High dose | 1.63 (0.96–2.79) | 1.73 (0.81–3.68) | 0.72 (0.41–1.26) |
| Inhaled/swallowed steroids | 0.20 (0.04–0.97)¶ | 0.43 (0.12–1.52) | 1.24 (0.37–4.15) |
| Swallowed steroids | 0.50 (0.10–2.59) | 0.44 (0.10–1.89) | 0.58 (0.10–3.22) |
| Long term care Post-EFI removal long term management | |||
| No, I don’t follow up | Ref | Ref | Ref |
| Only if I observe gross endoscopic abnormalities in the esophagus | 1.30 (0.50–3.39) | 0.76 (0.23–2.48) | 0.84 (0.32–2.22) |
| Only if the biopsies are abnormal | 0.39 (0.18–0.82)¶ | 1.58 (0.57–4.35) | 1.22 (0.61–2.47) |
| Yes, always | 4.16 (0.39–43.81) | – | 0.99 (0.12–8.06) |
| Post-EFI removal follow-up | |||
| Duration to clinic follow up follow-up | 0.98 (0.88–1.10) | 0.86 (0.76–0.97)¶ | 1.07 (0.95–1.19) |
| Follow-up EGD | 2.86 (1.67–4.91)¶ | 0.62 (0.31–1.25) | 0.67 (0.39–1.16) |
$
Association between adult gastroenterologists and pediatric gastroenterologists after adjusting for practice setting, location of practice, duration of practice, and estimated number of EFIs managed per year
¥
Association between gastroenterologists practicing in US and those practicing outside US after adjusting for sub-specialty training, practice setting, duration of practice, and estimated number of EFIs managed per year
€
Association between gastroenterologists in private practice and gastroenterologists practicing in academic setting after adjusting for sub-specialty training, location of practice, duration of practice, and estimated number of EFIs managed per year
¶
Two-sided P value ≤ 0.05