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

Abstract

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.

A nice meal turn dangerous: Steakhouse syndrome

“…A short observational period following the admission of the patient with acute food bolus obstruction is reasonable [7]. However, in a patient who is in distress and cannot swallow his own saliva, urgent endoscopy is warranted [8]. Time from symptom's onset to presentation is the only predictor of early resolution from food impaction, while medical therapy is ineffective in relieving acute obstruction and may delay definitive therapy [9].…”