A food bolus obstruction of the oesophagus represents a potentially serious medical problem. It is generally agreed that sharp objects becoming lodged in the oesophagus or objects with a corrosive capacity (eg batteries) should be removed urgently.1 However, the management of oesophageal soft food bolus obstruction (OSFBO) is less clear. The aim of treatment is to prevent the occurrence of potentially serious complications of bolus obstruction, including perforation and mediastinitis. These complications may occur due to mucosal ischaemia resulting from prolonged impaction or iatrogenically during surgical removal.2 In many cases, therefore, the aim of treatment is initially to manage the patient medically to encourage resolution of the obstruction.The management of patients with OSFBO frequently involves a variety of specialties, either individually or in combination. These include the emergency care, general surgery and ENT teams. Currently, however, there is no recognised guidance regarding which medications are efficacious in the resolution of OSFBO. Furthermore, the timing of administration of any medical or surgical treatment is often based entirely on clinical judgement. The aim of this study was to perform a literature review regarding the management of OSFBO.
MethodsA review of the literature was performed to evaluate the published evidence regarding pharmacological and surgical treatment of OSFBO. The Singleton Hospital library information department undertook searches of the Cochrane Library, the National Center for Biotechnology Information and the US National Library of Medicine resources. The following search strategies were used: > (oesophagus OR esophagus) AND buscopan -this yielded one case study 3 and two retrospective cohort studies;4,5 > (oesophagus OR esophagus) AND (cola OR coke OR coca-cola OR effervescent OR carbonated OR gas forming) -this yielded four retrospective cohort studies 6-9 and one case report; 10 > (oesophagus OR esophagus) AND glucagon -this yielded one randomised controlled trial 11 and two further studies;
RESULTSThis systematic review of the management of OSFBO shows no evidence that any medical intervention is more effective than a 'watch and wait' policy in enabling spontaneous disimpaction. Furthermore, the use of hyoscine butylbromide for OSFBO probably stems from a misquoted textbook. Surgical removal of an OSFBO is effective but not without potential risk. There is some evidence to support surgical intervention within 24 hours to prevent complications deriving from the initial obstruction. CONCLUSIONS There is a need for large double-blind, randomised, placebo controlled trials of drugs used in the medical management of OSFBO. Until the results from such trials are available, the treatment of OSFBO will remain based on inconsistent clinical judgement.