National trends in the utilization of office-based transnasal esophagoscopy

To analyze national trends in the prevalence of office-based transnasal esophagoscopy (TNE) procedures and compare with traditional operating room-based procedures utilizing transoral flexible and rigid esophagoscopy.

From 2013 to 2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 43,197/43198: diagnostic transnasal flexible esophagoscopy/with biopsy, 43200/43202: diagnostic transoral flexible esophagoscopy/with biopsy, 43191/43193: diagnostic rigid esophagoscopy/with biopsy. For each CPT code, the total number of charges billed to the Medicare database in each calendar year were recorded and analyzed using trendlines and linear regression.

From 2013 to 2022, there was a significant decrease in the prevalence of transoral flexible esophagoscopy, both diagnostic (trendline slope = -1078, R² = 0.83) and with biopsy (trendline slope = -192, R² = 0.80). The prevalence of rigid esophagoscopy, both diagnostic and with biopsy, remained stable (trendline slope = -51, R² = 0.14; trendline slope = -9.6, R² = 0.26, respectively). Diagnostic TNE represented a small percentage of total diagnostic esophagoscopies performed (range: 9.37-14.94 %), and this percentage remained relatively constant over time (trendline slope = 0.0017, R² = 0.08). TNE with biopsy was a small percentage of total esophageal biopsy procedures (range: 6.54-10.66 %), with a slight increase over time as a percentage of all esophageal biopsies performed (trendline slope = 0.0037, R² = 0.48).

Benefits of office-based TNE procedures include the avoidance of general anesthesia, shorter procedure times, and cost savings. However, TNE remains a small percentage of all esophagoscopies performed, without significant trends toward increased utilization. Further investigation is needed to evaluate the lack of utilization of these office-based procedures.