PTH-001 Endoscopic management and outcomes for patients with food bolus obstruction

Abstract

Introduction Food Bolus Obstruction (FBO) often presents as an emergency, with an estimated incidence of 13 per 100 000 population (Longstreth et al. Gastrointest Endosc 2001;53:193–8). Endoscopic management is required in many cases, but carries a risk of complications. Our aim was to audit the management and outcomes for patients with FBO admitted to our institution. Methods We reviewed all cases presenting with FBO to the Emergency Department and/or admitted to the hospital between October 2014 and October 2017. Data was retrieved from the hospital electronic patient records for demographics, duration of stay, performance of endoscopy as well as the endoscopic findings, FBO removal technique and any complications. Results A total of 160 patients presenting with FBO were identified; 103 (64%) males and 57 (36%) Females, average age of 65 years. Of these, 55 (34%) patients passed the food bolus spontaneously without a referral for endoscopy. Of the 105 (66%) patients who had an endoscopy, data on the time of admission and the time of endoscopy was available for 62 (59%) patients. 11 (18%) patients had endoscopy within 4 hours and 51 (82%) within 24 hours. At endoscopy, an addition 32 (30%) patients were found to have passed the food bolus spontaneously, whilst 72 (70%) needed endoscopic intervention; the push technique was most often employed (33% of cases). Endoscopic therapy was effective in 66 (91.2%) patients. Of the 6 patients in whom initial endoscopic therapy was unsuccessful, 2 patients were intolerant of the procedure (one required an endoscopy under general anaesthetic, and the other patient underwent a repeat procedure the following day successfully); 2 patients had FBO at a high level requiring ENT referral; 2 patients sustained an oesophageal perforation). The underlying pathology was documented as benign stricture/web/Schatzki ring in 20 (19%) of cases, oesophagitis in 12 (11%), oesophageal malignancy in 9 (8%), hiatus hernia in 3 (3%), eosinophilic oesophagitis 1 (1%), oesophageal spasm 1 (1%), Barrett’s oesophagus 1 (1%) and candidiasis in 1 (1%); 57 (55%) of patents had no underlying oesophageal abnormality. Endoscopic complications were seen in 4 (4%) patients – mucosal tear in 2 cases and perforation in 2 cases. The duration of hospital stay was 1 day in 136 (85%), 2 days in 16 (10%) and 3 or more days in 8 (4%) of cases. Conclusion FBO resolves spontaneously in around half of cases. Endoscopic therapy has a high success rate for the remaining patients, but is associated with a small risk of complications.