Glucagon May Reduce Time Between Esophageal Food Impaction (EFI) and Removal in Patients Undergoing Esophagogastroduodenoscopy (EGD)

Abstract

Introduction: Glucagon has been used for management of acute esophageal food impaction (EFI) for nearly 50 years. There are conflicting results of efficacy and safety of glucagon for this indication; most studies showing efficacy in only 1/3rd patients. We hypothesize that glucagon may help reduce the duration between EFI and EFI removal in pts undergoing EGD. Methods: We retrospectively identified consecutive pts between January 2014 and December 2015 who presented to Yale-New Haven Hospital with EFI. For each patient, we recorded demographics, co-morbidities, medications, laboratory parameters, rates of adverse events, rates of recurrent impaction and mortality. Pts who received glucagon and underwent EGD (EGD+Gluc) were compared with those undergoing EGD without glucagon (EGD-Gluc). We used Stata (version 14.1) for statistical analysis. Results: Among 86 pts with esophageal food impaction, 51 pts (59.3%) were females, with female to male ratio of 1.5:1. Mean age of the pts was 51.3 years and most of the pts (69, 80.2%) were Caucasians. Majority (68, 85.0%) were obese with BMI ≥ 30. They were more likely to have a history of alcohol use (32, 60.4%).Most common esophageal disease associated with impaction included GERD (24, 27.9%) and eosinophilic esophagitis (13, 15.1%). Mean time to presentation since ingestion was 8.9±12.0 hours. Most common food (76, 90.5%) causing impaction was meat and the most common site of impaction was distal esophagus (26, 46.4%). Most common pharmacologic agent used for management was glucagon (36, 41.9%) with mean dose of 1.2±0.7mg.Of these, only 11 pts (30.6%) responded to glucagon with spontaneous passage of impacted food whereas 26 pts (72.2%) required EGD.71 pts (82.6%) underwent EGD; the most commonly used technique (26, 36.6%) was pushing followed by pulling (17, 23.9%). Most common EGD findings were esophagitis (28, 35.9%), rings (15, 19.0%) and strictures (12, 15.2%). Complications rate was minimal with only 1 pt (1.3%) developing perforation.Re-impaction rate was 27.3% in 3 months and 45.5% within 1 year.Mortality rate was low (2, 2.4%). Time between EFI and removal of food was lower in the EGD+Gluc group compared to EGD-Gluc group(13.7±12.3 hours vs 17.3±16.0 hours, P<0.001). Conclusion: Our study demonstrates that glucagon is effective in spontaneous passage of EFI in only 30% patients. However, addition of glucagon prior to EGD in EFI cases is safe and may help reduce the duration between impaction and removal of EFI.