Medical Disimpaction for Children With Organic Esophageal Foreign Body in the Era of Eosinophilic Esophagitis

Abstract

Objective: Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE.Methods: A retrospective chart review was performed using the International Classification of Diseases codes and the emergency department database of patients presenting with EFBI from January 2010 to December 2014. Response to MD was defined as symptomatic relief of obstruction. Age, object ingested, medical agent used, EoE status, complications, and outcome were recorded.Results: A total of 317 presentations of EFBI were identified during the study period, of which organic EFBI accounted for 101 impactions (31.9%). Medical disimpaction was attempted for 42 (41.6%) with organic EFBI, resulting in resolution of symptoms for 16 (38.1%). One child with EoE responded to MD compared with 15 without EoE (4.8% vs 71.4%, P < 0.0001). Conclusions: Medical disimpaction was ineffective in children with EoEbut may be of help with symptom resolution in approximately 70% of children without EoE.

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

“… 40 There is no evidence that conservative treatments such as fizzy drinks, baclofen, salbutamol or benzodiazepines are helpful in the management of this condition. 41 There is no clear evidence for or against a bolus push or bolus extraction technique at endoscopy, 37 42 but it is important to have anaesthetic support available for airway management if the airway could be compromised with adequate sedation. If a stricture is identified with macroscopic signs of EoE, then it is possible to perform an immediate dilatation, but in most cases (70%) there is no stricture once the bolus has been removed.…”

“…The key to initial management is reassurance and assessment of the risk of perforation, followed by urgent interventional endoscopy to remove the food bolus and take oesophageal biopsies 40. There is no evidence that conservative treatments such as fizzy drinks, baclofen, salbutamol or benzodiazepines are helpful in the management of this condition 41. There is no clear evidence for or against a bolus push or bolus extraction technique at endoscopy,37 42 but it is important to have anaesthetic support available for airway management if the airway could be compromised with adequate sedation.…”