Comparison of Cap-Assisted vs Conventional Endoscopic Technique for Management of Food Bolus Impaction in the Esophagus: Results of a Multicenter Randomized Controlled Trial

Abstract

INTRODUCTION: “Push” or “pull” techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial. METHODS: Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables. RESULTS: Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90). DISCUSSION: This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.

Bolusobstruktionen im Ösophagus – Eine Analyse über 5 Jahre

“…Auch bei den Kindern blieb in etwa 20 % die Ursache unklar. Die Ergebnisse unserer Studie entsprechen anderen Publikationen [10,11,12,13,14].…”

“…nur in selteneren Fällen Verwendung. Unsere Ergebnisse entsprechen ebenfalls aktuellen Publikationen und einer Metaanalyse, in der die Vorteile einer Endoskopie-Aufsetzkappe berichtet wurden [10,11,12,13,14]. In der aktuellen Leitlinie [6] wird mit schwacher Empfehlung und geringer Evidenz zur Entfernung eines impaktierten Nahrungsbolus ein vorsichtiges Vorschieben in den Magen empfohlen.…”

Adverse events associated with EGD and EGD-related techniques

“…In a recent multicenter randomized trial of 342 patients with food bolus impactions, the use of a soft, oblique, cap-assisted approach was associated with a significantly lower risk of mucosal tears and bleeding compared with a conventional approach (.0% vs 7.6%). 44…”

Enhanced suction for removal of esophageal food impaction

“… 1 Conventional methods of removing impacted food boluses with devices such as polypectomy snares, rat-tooth forceps, alligator forceps, or polyp graspers are less effective and are time-consuming when used for a tightly impacted food bolus that easily becomes fragmented when removal is attempted. 2 , 3 , 4 In such patients, increased procedural time puts them at risk of adverse events such as aspiration, prolonged intubation, perforation, and readmission. 1 …”