Glucagon Use During Endoscopy to Assist Push Technique in Food Impactions

Abstract

Introduction: Esophageal food impactions are a common indication for urgent upper endoscopy. Preprocedural glucagon, given to relax esophageal smooth muscle, increase spontaneous bolus passage, and thus avoid the need for endoscopy, has been shown to have limited efficacy. Endoscopic therapies, including push and extraction techniques, are often challenging, prolonged, and associated with increased risk of complications. We aim to investigate the effectiveness of perioperative glucagon administration on the success rate of bolus advancement with simple push technique and its impact on procedural duration. Methods: A retrospective, single center, chart review was performed utilizing an electronic medical record over a three-year period selecting for patients age 18 or older with an ICD-9 code of 935.1 (foreign body in esophagus) who underwent an EGD. The measured outcomes were success rate, defined as advancement of food bolus into the stomach with gentle pressure without reduction of bolus size or retrograde extraction, and procedural time between two groups, with and without use of periprocedural glucagon. Results: 150 total patient encounters were identified, 53 of which were excluded due to spontaneous bolus passage, presence of a nonfood foreign body, missing data, suspected underlying dysmotility, or patient refusal of procedure. 97 patients remained in the study; 11 received perioperative glucagon based on physician preference. Glucagon use was associated with a higher success rate (73%) than without (67%), however this was not statistically significant (p=0.579) when controlled for age and gender. Mean procedure time was shorter in the glucagon group at 7.54 min vs 14.93 min in the control group, but did not reach statistical significance (p=0.077). All procedure related complications occurred in the non-glucagon group, but the small sample size precluded it reaching statistical significance. Conclusion: The use of perioperative glucagon trended with an increased success rate of esophageal food bolus advancement into the stomach, decreased procedural duration and lower procedural complications. Though these results were not found to be statistically significant in our small sample size, we feel they hold promise to support further research.498_A Figure 1 No Caption available.498_B Figure 2 No Caption available.498_C Figure 3 No Caption available.