Glucagon for the Relief of Esophageal Food Impaction Does It Really Work?

Abstract

We sought to evaluate our experience with glucagon used in the emergency department setting to relieve esophageal food impaction (EFI). We reviewed the records of patients with food impaction who received glucagon between January 1998 and May 2003 and recorded patient demographics, medical history, symptoms following glucagon administration, and endoscopic findings. There were 92 episodes of food impaction in 85 patients. Thirty-three percent of the episodes resulted in resolution of symptoms following a dose of glucagon. Sixty-seven percent had symptoms of food impaction after glucagon and underwent upper endoscopy in the emergency room. Only previous solid food dysphagia was positively associated with response to glucagon. Patients who received glucagon plus a benzodiazepine were more likely to have resolution of the EFI. In our experience, glucagon appears to relieve food impaction in one third of patients treated. This result is comparable to previously published data examining glucagon and placebo. The lack of advantage over placebo questions the practice of glucagon administration for EFI.

The management of oesophageal soft food bolus obstruction: a systematic review

“…In the first study, all 92 were given glucagon and 30 disimpacted without surgery. 12 In the second study, only 10 of 106 patients given glucagon and 20 of 116 given no medication disimpacted without further intervention. 13 The results suggest that administration of glucagon is no more effective in relieving OSFBO than when no medication is given.…”

“…25 It has not been shown to be effective in treating oesophageal coins in children 26 but it has been used in the management of OSFBO. [11][12][13] A comprehensive search revealed a randomised controlled trial finding no significant difference when comparing glucagon combined with diazepam against placebo for treating OSFBO 11 and two studies investigating 92 12 and 222 13 cases of OSFBO. In the first study, all 92 were given glucagon and 30 disimpacted without surgery.…”

“…21 No literature was identified in which medical management of OSFBO led to perforation. Oesophageal lacerations: Of all the medical and surgical papers discussed above, only 3 (0.7%) of the 426 oesophagoscopy cases 1,[15][16][17][18] and one effervescent-managed patient 12 suffered oesophageal lacerations.…”

“…> (oesophagus OR esophagus) AND (cola OR coke OR coca-cola OR effervescent OR carbonated OR gas forming) -this yielded four retrospective cohort studies [6][7][8][9] and one case report; 10 > (oesophagus OR esophagus) AND glucagon -this yielded one randomised controlled trial 11 and two further studies; 12,13 Buscopan (+/-fluids only) (7) Spontaneous disimpactation (n=11) …”

Oesophageal bolus impaction: role of glucagon, glyceryl trinitrate and carbonated drink

“…Al‐Haddad et al . also concluded a lack of advantage of glucagon over placebo 2 . There is minimal evidence regarding the efficacy of GTN in the management of oesophageal food bolus impaction.…”