1705 Esophageal Food Impaction: Novel Use of Water Flushes and Esophageal Overtube as a Safety Indicator and Facilitator to Push Food Bolus Into the Stomach

Abstract

INTRODUCTION: Esophageal food impaction requires urgent intervention. A food bolus is removed endoscopically by extraction or push into the stomach. Due to risks of perforation, controversy exists between when to extract verses to push. There are no clear guidelines on when it is safe to push on a food bolus; endoscopists rely on their subjective experiences and judgments. We present a case of the novel use of water flushes and an esophageal overtube to determine the safety of pushing on a food bolus to facilitate its passage into the stomach. CASE DESCRIPTION/METHODS: A 69 year-old man presented to the ED 12 hours after ingesting a piece of steak and a sensation of food stuck in his throat. The patient underwent esophagogastroduodenoscopy (EGD), which showed a large meat bolus firmly fixed in the upper esophagus. An overtube was placed to protect the airway. Extraction was attempted in piecemeal fashion. Because the food bolus was soft, only tiny pieces were retrieved with each attempt. We used water flushes to help determine when it would be safe to push the bolus. Initially, water retained proximal to the bolus (refluxed back into the overtube), suggesting that there was a complete luminal obstruction and that pushing would be ineffective and unsafe. Later, after more of the bolus was extracted, water passed beyond the bolus distally (no longer refluxed back into the overtube), indicating partial luminal obstruction and that it may be safe to push the food bolus. With a gentle push, the food bolus passed into the stomach easily. DISCUSSION: In esophageal food impaction, there are no clear guidelines on when it is safe to attempt the push method. We demonstrate a novel way of using water flushes and esophageal overtube to help objectively decide when it might be safe to push the food bolus. If water is retained and refluxed into the overtube, there may be a complete luminal obstruction and push is not recommended. If water does not accumulate or refluxed into the overtube, there is an opening in the lumen allowing the water travel distal to the bolus and pushing the food bolus may be considered. The use of water flushes and an esophageal overtube is safe, easy and cost-effective. It may serve as an additional safety indicator to help decide when to push the food bolus. In addition, water may moisturize the food bolus and help loosen the impaction to facilitate its passage into the stomach.