The Use of Acetylcystine in Esophageal Food Impaction

Abstract

Esophageal food impaction is a problem that faces the gastroenterologists in people with underlying esophageal strictures or altered esophageal anatomy. The only effective treatment so far is endoscopic removal of the food impacted or surgical intervention if the previous modalities failed. We describe here the use of acetylcystine in dissolving food impaction after failure of endoscopic treatment Case 1: Mrs. K.E is 40 year old female with previous history of multiple esophageal surgeries. Presented to the ER with food impaction after chicken meal. On exam there was a large soft lump in her neck suggestive of the food bolus, emergency EGD was performed which showed large food bolus impacted in the mid third of her esophagus, multiple attempts to remove it was unsuccessful. Termination of the procedure was decided, patient was sent back to the floor and was started on 15 cc of acetylcystine in 50 cc of water to give 5 cc every 5 min till finished every 8 hours. after 24 hour, repeat EGD showed complete resolution of the food bolus and patent esophagus Case 2: Mr. J.H is 50 year old male patient with old history of reflux esophagitis, presented with history of food impaction turkey sandwich, he was complaining of chest pain and difficulty to swallow. Emergency EGD showed large food bolus impacted in the distal esophagus that was difficult to remove secondary for being cement-like which made difficult to be grasped by forceps and was large for a snare to hold. After termination of the procedure, the patient was sent to the telemetry unit for close observation and surgery consult was obtained for possible surgical intervention, meanwhile the patient was started on acetylcystine with the same previous regimen. Repeat EGD in 24 hour showed complete clearance of his esophagus with evidence of underlying esophageal peptic stricture. Discussion: Food impaction in the esophagus is not uncommon problem that we face in our institution however, endoscopic treatment is usually sufficient and result in quick recovery and discharge from the hospital. Recently, we had more cases of food impaction that is difficult to treat secondary for being large in size or cement like structure. There was few reported cases of using acetylcystine in the treatment of stomach bezoar with success, using its mucolytic characteristics in dissolving the food bolus. The acetylcysteine softens the bezoars allowing an easier and faster fragmentation by mechanical means. Depending on this theory, we used it in treating difficult cases of food impaction of the esophagus with success so far. However more studies are needed to prove or disprove the efficacy of acetylcystine in this settings.