394 Esophageal Food Impaction - A Retrospective Chart Review

Abstract

INTRODUCTION: Esophageal Food Impaction (EFI) is the third most common non-biliary emergency in gastroenterology with an estimated annual incidence rate of 13 episodes per 100,000 person-year and resulting in 1500 deaths per year. Patient’s presenting with food impaction often have underlying esophageal pathology. Esophageal dysmotility is one of them which can be seen in diabetics and 60% of these patients have manometric abnormalities which may be associated with increased risk of food impaction but limited studies have been done to evaluate these correlations. The possible risk factors and association with diabetes in EFI was evaluated in our study. METHODS: Retrospective chart review of 455 patients who presented to the Staten Island University Hospital with symptoms of food impaction from 1999 to 2017. A retrospective analysis was undertaken on relevant clinical data such as age, risk factors, type of bolus, location, administration of glucagon, endoscopic technique, complications, and outcome. RESULTS: Overall, 174 patients had endoscopically confirmed FI with males 102/174 (58%). Esophageal pathology found in endoscopy includes esophagitis in 58/174 (33%), stricture in 43/174 (24%), hiatal hernia in 29/174 (17%), Schatzki ring in 15/174 (9%), normal endoscopy in 32/174 (19%) (Figure 1). Diabetes was reported in 20/174 (11%) (Figure 2). Type of food was meat in 73/174 (41%). Location of EFI mainly in the lower one-third of the esophagus in 94/174 (61%). Endoscopic push technique was used in 95/174 (55%), pull technique in 83/174 (48%). Endoscopy was successful for the first time in 165/174 (96%) patients. Complications were reported in only 5/174 (3%) including perforation and tear. Glucagon was given to 74/174 (43%) and mean door to endoscopy time (time of presentation to the emergency department to endoscopy procedure) was 10 hours in patients received glucagon, 13 hours in patients who didn’t receive glucagon (Figure 3). CONCLUSION: EFI is more common in males. Esophageal stricture and hiatal hernia were the most common pathologies found in endoscopy. Esophagitis is found in 33% of patients but whether it is the culprit for FI or consequence of FI is not clear. Diabetes is associated with food impaction in only 11% of patients but more studies are needed to find out the true association. Administration of glucagon resulted in the decreased door to scope time. Endoscopy is a safe and effective method for food impaction and complications reported were minimal.