Postendoscopy Care for Patients Presenting With Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study

Abstract

Background & Aims: Esophageal food bolus impactions (FBIs) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction, but also medical follow-up and treatment for the underlying esophageal pathology. We evaluated the appropriateness of post-endoscopy care for patients with FBIs, and assessed patient-, physician- and system-related factors that may contribute to loss to follow-up. Methods: We conducted a retrospective, population-based, multi-center cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada from 2016-2018. Appropriate post-endoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton pump inhibitors, endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression. Results: A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate post-endoscopy care. Half of patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and amongst this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including three new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio 7.28 [95% CI: 4.49-11.78], p<0.001) more likely to receive inappropriate post-endoscopy follow-up and treatment, even after adjusting age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions. Conclusions: One quarter of patients presenting with an FBI do not receive appropriate post-endoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.