462 A Retrospective Review of Effervescent Granules and Glucagon for the Management of Esophageal Food Impactions in a Community Hospital

Abstract

INTRODUCTION: Esophageal food impaction is one of the more common GI emergencies. While endoscopy is the definitive therapy, pharmacologic therapy does have a role. Despite minimal success, because of the safety profile glucagon is currently recommended as the initial pharmacologic therapy.1–5 Effervescent agents have been limited due to previous concerns of perforation, but studies have been revisited recently with safety and success.5–7 Our aim is to measure EG and glucagon as a primary pharmacologic agent. METHODS: A retrospective study was performed on all patients over 18 between 6/2015-5/2018, with diagnosis of esophageal obstruction or foreign body. Exclusion was transfer to outside facility. Records were reviewed for administration of glucagon and/or effervescent granules, if relief of obstruction was achieved, patient's ability to tolerate secretions and food responsible. Etiology was determined from history, endoscopy report, imaging, and pathology. T-test was performed for statistical significance. RESULTS: Demographic data, along with food bolus types and diagnoses can be found in Table 1. EG was attempted as an initial modality in 20.2% of cases and glucagon in 16.8%. EG was more successful when compared to glucagon (51.2 % vs 14.7%) (P = 0.0216). EG was successful as secondary modality in 75% of cases after glucagon initially failed, as compared to glucagon in 0% (0/9) of cases when EG initially failed (P = 0.0094). Figure 1 highlights success of EG and Glucagon based on diagnosis. There were no major safety events. CONCLUSION: Overall, EG is safe; and appears to overall be more efficacious than glucagon as initial pharmacologic therapy for EFI. This is a worthwhile therapy for both those who are tolerating secretions and those who are not, while glucagon seems to be more effective for secretion tolerant patients. EG was highly successful in patients tolerating secretions, however with a success rate of over 50% with no complications, we suggest it is worth attempting even in those who are not.