Timing and Outcomes of Endoscopy for Esophageal Food Bolus Impaction

Abstract

Background: The etiology, natural history, urgency, and timely management of esophageal food bolus impaction (EFBI) are not well known. Objective: To determine the optimal timing for endoscopic disimpaction and outcomes. Design: Retrospective observational cohort study. Setting: Urban community hospital. Patients and Methods: Patients with EFBI who presented to the ED were reviewed. Patient demographics, times from symptom onset to ED visit and times from ED to Endoscopy, endoscopic findings, and other data were analyzed. Results: Of 105 patients with EFBI, 74 required endoscopy, 31 cleared spontaneously. At endoscopy, 5 boluses (7%) had already passed into the stomach; 29 (39%) were pushed into the stomach using the endoscope; 6 (8%) were removed with rat tooth forceps; 16 (22%) were removed using the Roth net. The time from EFBI until arrival differed significantly between subjects who resolved spontaneously and those who received an EGD. Fifty percent of subjects resolved spontaneously within 3.3 hours, and 50% of subjects who received an EGD did so within 4.0 hours. The longest time from arrival until resolution was 13.1 hours for subjects who resolved spontaneously and 19 hours for those who received an EGD. There was a significant direct relationship between subjects’ age and time from EFBI and arrival but not between subjects’ age and time from arrival until resolution. Limitations: Retrospective, single-center, community study. Conclusions: Endoscopic disimpaction for EFBI is safe and effective even if it is performed within 10 hours after presentation. Overall, EFBI is not an endoscopic emergency and carries a favorable outcome.

The Midnight Calculus of Esophageal Obstruction: Commentary on Timing and Outcomes of Endoscopy for Esophageal Food Bolus Impaction

“…In fact, as the authors reference, it’s the third most frequent non-biliary GI emergency following upper and lower gastrointestinal hemorrhage. 1 The annual incidence of esophageal food bolus impaction in the US approximates 16/100 000 people. Despite the frequency and volume of cases, a dearth of literature exists.…”