Influence of pre-endoscopic duration of esophageal food impaction on endoscopy time and postprocedure adverse events

Abstract

ObjectivesEsophageal food bolus impaction is a medical emergency and 10-20% of impacted food boluses will require endoscopic removal. Emergent and prolonged procedures are associated with increased adverse events. We are interested in the relationship between the pre-endoscopic duration of esophageal food impaction and the duration of esophagogastroduodenoscopy (EGD) performed to remove the impacted food bolus.MethodsBetween 2010 and 2021, we examined EGD procedures performed for esophageal food impaction. Subjects were classified according to pre-endoscopic duration of food impaction.ResultsWe found a positive correlation between pre-endoscopic duration of food impaction and procedure length (r=0.18). Esophageal impactions with mixed foods resulted in the longest procedure duration (p<0.05). Increasing age, male gender, and duration of impaction greater than 42 hours were significantly associated with increased procedure duration (p<0.05). Esophageal perforations, prolonged intubations, admissions following EGD, and readmissions were associated with EGD duration greater than 25.5 minutes. No adverse events occurred in patients who underwent EGD within 6 hours of symptom onset.ConclusionsIn the case of an esophageal food impaction, the time between symptom onset and endoscopy is positively correlated with procedure length and risk of adverse outcomes. We suggest that food impaction should remain an indication for emergent endoscopy. Prospective studies evaluating the safety and outcomes of prolonged time to endoscopy will further clarify the management of esophageal food impactions.

Enhanced suction for removal of esophageal food impaction

“…Food impaction is a common endoscopic emergency that requires prompt removal of the impacted food bolus to avoid esophageal and extra-esophageal adverse events. 1 Conventional methods of removing impacted food boluses with devices such as polypectomy snares, rat-tooth forceps, alligator forceps, or polyp graspers are less effective and are time-consuming when used for a tightly impacted food bolus that easily becomes fragmented when removal is attempted. 2 , 3 , 4 In such patients, increased procedural time puts them at risk of adverse events such as aspiration, prolonged intubation, perforation, and readmission.…”

“… 2 , 3 , 4 In such patients, increased procedural time puts them at risk of adverse events such as aspiration, prolonged intubation, perforation, and readmission. 1 …”