240 Improving Adherence to Oesophageal Biopsy Protocols for Suspected Eosinophilic Oesophagitis: A Quality Improvement Project

Abstract Aim Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated condition that has become an increasingly recognised cause of oesophageal dysphagia, particularly in younger individuals. Accurate diagnosis requires histological confirmation, which depends on adequate mucosal sampling during oesophagogastroduodenoscopy (OGD). Current guidelines from the British Society of Gastroenterology (BSG) and United European Gastroenterology (UEG) recommend taking at least six biopsies from two or more oesophageal levels. This Quality Improvement Project (QIP) aimed to assess local adherence to these biopsy protocols and identify opportunities for improvement. Method A retrospective review of 250 patients referred via the two-week wait (2WW) pathway for dysphagia and upper gastrointestinal symptoms was conducted over a four-month period (December 2024 to March 2025). Following the exclusion of 42 patients with non-EoE indications, 208 patients were included. Data were collected on biopsy number, anatomical distribution, and quality of documentation. Results Of 174 patients presenting with dysphagia, 121 (69.5%) received six biopsies. Seventeen (9.8%) received four biopsies, three (1.7%) received five, and 11 (6.3%) had fewer than four biopsies. Seven to eight biopsies were taken in 4.0% of cases. Documentation was suboptimal: 66 (37.9%) had multilevel biopsies with unspecified locations, and only 40 (23.0%) had clearly documented segmental biopsies. In the food bolus group (n=7), 71.4% received multilevel biopsies. Conclusions: Adherence to biopsy protocols and documentation standards for suspected EoE remains inconsistent. Targeted interventions are being implemented, including clinician education, updated documentation templates, and procedural checklists. A re-audit will assess their impact.