(728) To Scope or Not to Scope: Early Endoscopic Evaluation and Outcomes in Acute Angioedema

Introduction: Acute head and neck angioedema can rapidly progress to critical airway compromise. Early endoscopic evaluation may help identify patients at risk for airway involvement, but studies assessing its impact are limited.

Methods: A retrospective, multi-institutional analysis was performed using deidentified electronic health records from 69 healthcare organizations within the TriNetX US Collaborative Network. From January 2015 to December 2025, adult patients (≥18 years) with severe angioneurotic edema were identified using ICD-10 code T78.3. The early endoscopic evaluation cohort was defined as patients who received laryngoscopy or nasopharyngoscopy within 1 day of the index angioedema event compared with those who did not. Patients with complement system defects (ICD-10 D84.1) were excluded. Cohorts were propensity-score matched (PSM) 1:1 for age, sex, race, ethnicity, and comorbidities (greedy-neighbor, caliper 0.1 SD). Time-to-event analyses were performed using Cox proportional hazard analysis. The outcomes within 30 days included emergency department (ED) visits, hospital admissions, intensive care unit (ICU) admissions, and endotracheal intubation.

Results: After PSM, 609 patients were matched for both the early endoscopic evaluation cohort (mean [SD] age, 56.1 [15.5] years, 269 female [44.2%]) and the no early endoscopic evaluation cohort (mean [SD] age, 55.8 [15.7], 269 female [44.2%]). Within 7 days of index, patients with early endoscopic evaluation experienced lower rates of intubation (Hazard Ratio [HR], 0.34, 95% CI, 1.19-0.60). Within 30 days of index, patients with early endoscopic evaluation experienced lower rates of hospital admissions (HR, 0.23, 95% CI, 0.19-0.29) and ICU admissions (HR: 0.22, 95% CI, 0.16-0.29), whereas rates of ED visits did not significantly differ.

Conclusions: These findings suggest that early endoscopic evaluation may help identify clinically significant airway involvement and prevent intubations and subsequent ICU admissions, though further research is needed to refine patient selection and timing.