OTU-12 Validation of Edinburgh dysphagia score in a national evaluation of upper GI cancer 2ww pathway

IntroductionBritish Society of Gastroenterology has recommended to use the Edinburgh Dysphagia Score (EDS) (with a cut off ≥ 3.5) to risk stratify dysphagia referrals during the endoscopy COVID recovery phase. We have validated EDS performance in a national prospective evaluation of the UGI cancer two week wait pathway and developed a modified scoring system with improved diagnostic accuracy.MethodsData on patients referred with dysphagia on the 2WW pathway between May 2020 and February 2021 to 19 centres across the UK were collected at telephone triage and recorded on a standardised data collection tool. Sensitivity and Negative predictive values were calculated for EDS ≥3.5. Forward stepwise logistic regression model identified the factors associated with UGI cancer and their regression coefficients were used to develop a modified scoring system, called Cancer Dysphagia Score (CDS). Diagnostic accuracy was examined by comparing area under the receiver operating curves (AUROC).Results1496 patients were studied: median age 62 (IQR 51-73), 58% female. Median EDS score was 4 (IQR 2.5-6); with 67% having an EDS ≥ 3.5. 64% were triaged to 2WW endoscopy; 18% to urgent (but not 2WW) endoscopy; 2.8% to urgent CT scan; 5.5% to routine OGD; and 4.4% to barium swallow. After excluding patients who declined investigation, results were available for 96%.91 UGI cancers were diagnosed (prevalence 7.1%); with 3 (3%) UGI cancers diagnosed in patients with EDS