Esophageal Food Impaction: A Retrospective Chart Review

Abstract

Background: Esophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology, with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. Patients presenting with food impaction often have underlying esophageal pathology. We evaluated the possible risk factors for EFI in our study. Methods:We performed a retrospective chart review of 455 patients at Staten Island University Hospital (SIUH) that presented with symptoms of food impaction from 1999 to 2017. We analyzed relevant clinical data such as age, risk factors, type of food bolus, location, administration of glucagon, endoscopic technique and complications.Results: Overall, 174 patients had endoscopically confirmed EFI. The majority were males 102/174 (58.6%). Esophageal pathological findings included esophagitis in 58/174 (33.3%), strictures in 43/174 (24.7%), hiatal hernias in 29/174 (16.6%) and Schatzki's rings in 15/174 (8.6%). Thirty-two out of 174 (18.3%) had normal endoscopic findings. Diabetes mellitus (DM) was reported in 20/174 (11.4%) patients. The type of food impacted was mostly meat in 73/174 (41.9%) cases. The location of EFI was mainly in the lower one-third of the esophagus in 94/174 (54%). The endoscopic push technique was used in 95/174 (54.5%) patients and the pull technique in 83/174 (47.7%) cases. The endoscopic therapeutic intervention was successful as a first attempt in 165/175 (94.8%) patients. Complications were reported in only 5/174 (2.8%), and these mostly comprised of perforations and tears. Glucagon was given to 74/174 (42.5%) patients. The median door-to-scope time (time of presentation at the emergency department to endoscopic intervention) was 7 h (range 1.5 -24 h) in patients who had received glucagon as opposed to 7 h (range 1 -24 h) in patients who did not receive it. Conclusion:EFI is more common in males. Esophageal strictures and hiatal hernias were the most common pathologies found in endoscopy. Esophagitis was evident in 33.3% of patients, but if it was the cause or consequence of EFI is not clearly understood. DM was associated with food impaction in only 11.4% of patients, but more studies are needed to determine if DM has a stronger association with EFI. The door-to-scope time was shorter in patients who had received glucagon. Endoscopy is a safe and effective therapeutic intervention for EFI, and complications reported were minimal.

Timing and Outcomes of Endoscopy for Esophageal Food Bolus Impaction

“…A retrospective chart review of 455 patients analyzed age, risk factors, type of food bolus, location, administration of glucagon, endoscopic technique, and complications. 2,3 The authors found EFBI is more common in males. Esophageal strictures and hiatal hernias were the most common underlying pathologies found in endoscopy.…”

“…1 Prior to 30 years ago, rigid esophagoscopy performed with the patient under general anesthesia was the standard method of disimpaction used in most hospitals. Subsequently, flexible endoscopic management in the ED using conscious sedation and, more recently, monitored anesthesia care or rarely general anesthesia [2][3][4][5][6][7][8] became common. Most endoscopists prefer bolus extraction, but pushing the bolus into the stomach using the endoscope has also been suggested 2 In most series, patients with EFBI have been designated as having "foreign bodies" and have been included with patients who swallowed objects, such as coins, pins, razors, and batteries.…”

“…Subsequently, flexible endoscopic management in the ED using conscious sedation and, more recently, monitored anesthesia care or rarely general anesthesia 2-8 became common. Most endoscopists prefer bolus extraction, but pushing the bolus into the stomach using the endoscope has also been suggested 2…”

Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial

“…Underlying oesophageal pathology is nearly always present, with structural abnormalities and eosinophilic oesophagitis being the most common diagnoses. Impacted food boluses most often consist of meat 234…”

The Midnight Calculus of Esophageal Obstruction: Commentary on Timing and Outcomes of Endoscopy for Esophageal Food Bolus Impaction

“…Gurala and Polavarapu published a retrospective series of 174 patients with EFBI. 7 The median door to scope time was 7 hours. Complication rates were low 5/174 (2.8%) consisting of perforation (2) and tears (3).…”