Glucagon Is a Safe and Inexpensive Initial Strategy in Esophageal Food Bolus Impaction

Haas, Jason; Leo, Julia; Vakil, Nimish

doi:10.1007/s10620-015-3934-z

Cited by 20 publications

(32 citation statements)

References 9 publications

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“…2,3,5,6 There are multiple treatment methods for esophageal food impaction, including ingestion of carbonated beverages, medications that affect esophageal motility (glucagon and nitrates most commonly), and endoscopic or surgical removal of the food bolus. [7][8][9][10][11][12] Spontaneous resolution has been reported in up to 25% of food impaction patients. Medications have been effective in nearly 40% and endoscopy in more than 95% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Medications have been effective in nearly 40% and endoscopy in more than 95% of patients. [7][8][9][10][11] Historically, removal of the food impaction by retrieval and retrograde removal by mouth has been recommended because of concern that pushing the bolus into the stomach may lead to complications in the setting of luminal narrowing. However, the push technique is likely used frequently in practice, and a recent study has suggested the technique is safe and effective.…”

Section: Introductionmentioning

confidence: 99%

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The evolution of treatment and complications of esophageal food impaction

et al. 2019

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Background: Esophageal food impaction is relatively common and increasing over time. Treatment ranges from medications to invasive endoscopic therapies. The endoscopic push technique has been advised against in favor of endoscopic retrieval for safety concerns. We sought to assess use patterns and safety of treatments for food impaction in a population-based retrospective review. Methods: A database of recorded esophageal food impactions in Olmsted County, MN, USA, from 1975-2011 was reviewed for patient demographics, treatment, and complications. Results: A total of 645 impactions occurred, with increasing incidence over time, peaking at 23.2 per year (2000)(2001)(2002)(2003)(2004). Medications (almost exclusively glucagon) were successful in relieving impactions 34.5% of the time when trialed. Urgent endoscopy was common (74.0%), as was the need for endoscopic therapy (67.1%). Endoscopic therapy increased over time, with the endoscopic push technique becoming most common. Esophageal complications (deep mucosal injury or perforation) increased over time but remained rare (peak 11%). There was no difference in complications between push and retrieval techniques. Conclusions: The endoscopic push technique is safe in comparison to endoscopic retrieval in esophageal food impactions. While complications surrounding impaction have increased, they remain rare. Medication trials are reasonable, as long as they do not delay endoscopy, and may prevent the need for emergent endoscopy in one-third of cases.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The evolution of treatment and complications of esophageal food impaction

et al. 2019

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“…A variety of non-endoscopic medications and interventions are described in the current medical literature; however, all of these alternatives are associated with limited or conflicting studies on their use [4] , [5] . Examples include: butyl scopolamine [6] , [7] , glucagon [8] , [9] , benzodiazepines [10] , calcium channel blockers [11] , nitrates [12] , [13] , meat tenderizers (which has been firmly discredited and the only treatment known to cause harm) [14] , and effervescent drinks (e.g. cola) [15] .…”

Section: Introductionmentioning

confidence: 99%

Cola therapy for oesophageal food bolus impactions a case series

Baerends

Boeije

Capelle

et al. 2019

African Journal of Emergency Medicine

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Introduction This retrospective case series describes the use of cola to immediately treat complete oesophageal food bolus obstructions in the emergency centre. Short of emergent endoscopy – which is invasive, expensive, not without adverse events, and often unavailable in low-resource settings – no other proven therapies exist to relieve oesophageal food impactions. Methods We performed a chart review of adults with complete oesophageal food bolus obstructions presenting to two Dutch emergency centres. Our primary outcome was cola’s success rate in resolving the obstruction. Our secondary outcome was adverse event occurrence. Results We identified 22 cola interventions in 19 patients, the majority of whom (77.3%) were male. The median age was 59 years (IQR 29–73). All presentations were due to meat impaction. Endoscopy revealed relevant upper gastrointestinal pathology in 54.5%. When initiated in the emergency centre, cola successfully resolved 59% of complete oesophageal obstructions. No adverse events were reported in patients successfully treated with cola. Discussion While keenly aware of our retrospective study’s limitations, we found a promising success rate for cola as an acute intervention for oesophageal food bolus impactions. We registered no adverse events attributable to cola. Also, given that cola is cheap, widely available and seemingly safe we believe it can be considered in patients with oesophageal obstructions due to food, either as pre-endoscopy treatment or in case endoscopy is not available at all. We think our findings provide an impetus for prospective research on this intervention.

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“…This likely reflects concerns regarding the risks of endoscopy, preference of a minimally invasive approach to management, anecdotal reports of benefit, difficulty assimilating unplanned emergent cases within busy elective endoscopy workloads and unclear management algorithms that include multiple specialties, including emergency physicians, gastroenterology, upper GI surgery and otolaryngology. Conservative therapies for FBO include glucagon, effervescent beverages, hyoscine, benzodiazepines, glyceryl trinitrate and opiates; however, there is no high‐quality evidence to support any of these approaches and safety concerns have been raised with some …”

Section: Introductionmentioning

confidence: 99%

“…Conservative therapies for FBO include glucagon, effervescent beverages, hyoscine, benzodiazepines, glyceryl trinitrate and opiates; however, there is no high-quality evidence to support any of these approaches and safety concerns have been raised with some. 6,[12][13][14][15][16][17] Ultimately the challenge in the management of FBO is to treat patients in an effective and timely manner, relieving symptoms, identifying underlying pathology and avoiding complications. Identification of patients in whom FBO is likely to resolve spontaneously, who may therefore be suitable for elective diagnostic endoscopy, may reduce some of the burden on emergency endoscopy services, while the impact of medical therapies on this timeline is unclear.…”

Section: Introductionmentioning

confidence: 99%

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

Fulforth

Chen

Falvey

2019

Emerg Medicine Australasia

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Objective To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. Methods A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. Results A total of 116 patients presented with symptoms of FBO. Twenty‐seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy‐one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). Conclusions Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.

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Glucagon Is a Safe and Inexpensive Initial Strategy in Esophageal Food Bolus Impaction

Abstract: Glucagon is low cost, is moderately effective, and may be considered as an initial strategy. Endoscopic removal regardless of technique is safe and effective. The yield of radiography is poor in the setting of food bolus impaction.

Cited by 20 publications

References 9 publications

The evolution of treatment and complications of esophageal food impaction

The evolution of treatment and complications of esophageal food impaction

Cola therapy for oesophageal food bolus impactions a case series

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

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