2858 Effervescent Granules Are an Effective, and Cost-Saving Strategy in Acute Esophageal Food Impaction

Abstract

INTRODUCTION: Acute esophageal food impactions (AEFI) are common. Effervescent granules (EG) consist of sodium bicarbonate and citric acid and create carbon dioxide (CO2) gas in the esophagus, which can raise the intraluminal pressure and force the bolus into the stomach. There are little published data describing EG in the treatment of AEFI. The primary purpose of this study was to evaluate the effectiveness and safety of EG in the emergency department (ED) setting in adult patients presenting with AEFI. Secondary objectives are to determine cost associated with EG, and to see if there are any patient characteristics that may predict successful response. METHODS: A prospective chart review of patients presenting to the ED with AEFI in a large tertiary referral teaching hospital, as well as from 2 sister community hospitals in the same metropolitan area from January 1, 2016 to December 31, 2018 was performed. Inclusion criteria were age 18 and older and clinical diagnosis of AEFI. Data collected included patient demographics, outcomes, cost and complications. Mann-Whitney testing was used to compare groups. Logistic regression was used to determine predictors of effectiveness. Successful response was defined as clearance of the food impaction avoiding the need for emergent endoscopy. RESULTS: Sixty AEFI presentations met inclusion criteria with mean age of 51.0 years (+/- 18.4) and mean BMI 29.1 kg/m2 (+/- 6.6). Other demographic variables are shown in Table 1. A total of 33 patients (55.0%) who received EG responded successfully. The median hospitalization cost associated with EG success was $1,743 (IQR $976-$2,427). For patients who failed to respond to EG, the median cost was $13,224 (IQR $10.563-$18,933) (P < 0.001). Of concern, there were 2 cases of esophageal perforation that both occurred in patients who failed to respond to EG but were only noted after EGD. One healed with conservative therapy (NPO, antibiotics) and the other with placement of a covered esophageal stent. Both made a full recovery. CONCLUSION: Effervescent granules are an effective and cost-saving initial strategy in the treatment of acute esophageal food impaction. Further study of the safety and effectiveness of effervescent granules is warranted.