Sweet Potato Esophagus

Abstract

Esophageal food impaction is one of the most common gastroenterology emergencies. Endoscopic removal is the treatment of choice and should be performed within 24 hours of an impaction given increased risk of complications if treatment is delayed. Retrieval nets, snares, and forceps are some of the commonly used devices to relieve esophageal food impaction. However, these methods may be insufficient in some cases. We describe a case of food impaction that was treated using a biliary balloon, direct suctioning, and water immersion. An 80-year-old female with a history of gastroesophageal reflux and dysphagia presented to our hospital with 48 hours of regurgitation of solids and liquids after eating sweet potatoes, but remained able to handle secretions. An EGD was pursued with initial views obstructed when passing the upper esophageal sphincter due to the presence of food debris. Over the next two hours, attempts with endoscopic retrieval nets and piecemeal removal with forceps through an overtube failed to yield significant progress. The following day, the patient was intubated for repeat EGD with planned removal of the remaining debris. Initially, a 15mm biliary extraction balloon was used to extract large chunks of debris, but with limited progress. Next, suction tubing was passed through the overtube alongside a stricture scope, allowing for rapid but safe clearance of debris via suctioning under direct visualization. Completion of the exam revealed a clear distal esophagus and otherwise normal stomach and duodenum. Presbyesophagus was appreciated as well as a possible stricture, which may have been contributing to the impaction. Although the distal esophagus was cleared, proximal esophagus debris was still present. Gradually the overtube was withdrawn and water immersion was used to push debris into the overtube allowing for further suctioning, and pushing the food distally. The patient tolerated the procedure well, was able to handle liquids without issue and was discharged with plan for repeat EGD in one week for biopsies and dilation. Biliary balloons, suctioning under visualization and water immersion with suctioning may be of significant utility to relieve esophageal food impaction when conventional methods have failed. Use of an overtube with intubation is necessary before employing such maneuvers to prevent aspiration. These unique techniques allowed us to remove a large amount of food debris that was not amenable to traditional methods. Watch the video: https://goo.gl/PJVU56