The evolution of treatment and complications of esophageal food impaction

Abstract

Background: Esophageal food impaction is relatively common and increasing over time. Treatment ranges from medications to invasive endoscopic therapies. The endoscopic push technique has been advised against in favor of endoscopic retrieval for safety concerns. We sought to assess use patterns and safety of treatments for food impaction in a population-based retrospective review. Methods: A database of recorded esophageal food impactions in Olmsted County, MN, USA, from 1975-2011 was reviewed for patient demographics, treatment, and complications. Results: A total of 645 impactions occurred, with increasing incidence over time, peaking at 23.2 per year (2000)(2001)(2002)(2003)(2004). Medications (almost exclusively glucagon) were successful in relieving impactions 34.5% of the time when trialed. Urgent endoscopy was common (74.0%), as was the need for endoscopic therapy (67.1%). Endoscopic therapy increased over time, with the endoscopic push technique becoming most common. Esophageal complications (deep mucosal injury or perforation) increased over time but remained rare (peak 11%). There was no difference in complications between push and retrieval techniques. Conclusions: The endoscopic push technique is safe in comparison to endoscopic retrieval in esophageal food impactions. While complications surrounding impaction have increased, they remain rare. Medication trials are reasonable, as long as they do not delay endoscopy, and may prevent the need for emergent endoscopy in one-third of cases.

The Risk of Esophageal Food Impaction In Eosinophilic Esophagitis Patients; The Role of Clinical And Socioeconomic Factors

“…9 However, more recent 2018 guidelines con rmed that PPI-REE is a subtype of EoE and is not a subset of GERD. 8,10,23 In our study, we used the updated EoE guidelines and did not exclude PPI-REE cases.…”

“…EoE patients may have progressive dysphagia and food impactions that require urgent endoscopic intervention in most cases, and can lead to life threatening esophageal perforation. 10 We studied our large cohort of EoE patients to identify the risk factors associated with esophageal food impaction. In addition to demographic and clinical factors, this study will also examine socioeconomic status of patients.…”

Endoscopic Image-guided treatment of Upper Gastrointestinal foreign body and nursing care of complications

“…We analyzed the clinical characteristics of endoscopic treatment of upper gastrointestinal foreign body cases, and summarize the experience of endoscopic treatment. 12 .…”

Consuming consumer products and the emergency department

“…To provide some perspective, during this same time period, food impactions in adults were far more common (w20/100,000), but the incidence has been stable to declining. 5 Understandably, the study of patients presenting with foreign body ingestion does not easily lend itself to rigorous clinical trials. The authors used a national consumer safety database to publish an interesting study in an area that is underrepresented in the scientific literature.…”

“…Food boluses are usually amenable to gentle advancement into the stomach. 2,5 For nonfood items, various devices exist for safe retrieval of objects, including hoods, overtubes, and foreign body forceps and nets. 1 The topic of endoscopic management of foreign body ingestion and food impaction has recently been extensively reviewed.…”