Acute Esophageal Food Impaction Research Articles

S567 Getting Unstuck: Comparing Glucagon and Effervescent Agent Therapy in Patients With Acute Esophageal Food Impaction

S567 Getting Unstuck: Comparing Glucagon and Effervescent Agent Therapy in Patients With Acute Esophageal Food Impaction

S2349 Not Just Another Food Bolus: Large Cell Neuroendocrine Carcinoma of the Esophagus Presenting as Acute Esophageal Food Impaction

Introduction: Food impactions arise due to structural or functional abnormalities along the GI tract most commonly at the esophagus. The differential diagnosis is broad but importantly includes malignancy. Here we highlight a rare case of food impaction secondary to high-grade neuroendocrine carcinoma. Case Description/Methods: A 71-year-old male with a history of asthma presented with trouble swallowing and epigastric pain 5 hours after eating a chicken sandwich. He had been experiencing dysphagia and odynophagia for the past 2 months, but symptoms were especially severe on day of presentation to the point that he was unable to eat or drink anything afterwards given persistent regurgitation. Urgent EGD showed a food impaction of the distal esophagus, which was successfully removed through suction cap revealing a circumferential fungating and necrotic appearing mass at 28 cm from the incisors (Figure). Biopsies were obtained, but the mass could not be traversed. Subsequent CT CAP showed a 6.7 cm distal esophageal mass correlating with endoscopic findings as well as nonregional lymphadenopathy concerning for metastatic disease. Pathology unfortunately revealed high-grade neuroendocrine carcinoma WHO grade 3 with small and large cell features. Patient was deemed not a surgical candidate given metastatic disease and was started on palliative chemotherapy. Discussion: Neuroendocrine carcinoma is a rare type of esophageal malignancy with an incidence of 0.4-2% of cases. Prognosis is usually poor given its aggressive nature and advanced stage at initial diagnosis. Treatment depends on the extent of disease. For those with limited disease, esophagectomy with lymph node dissection +/- adjuvant chemotherapy is warranted. On the other hand, extended disease relies upon palliative chemotherapy +/- adjuvant radiotherapy. Clinicians must maintain neuroendocrine carcinoma as part of their differential for food impaction given the life-altering implications that such a diagnosis holds.Figure 1.: EGD showing fungating and necrotic appearing mass at distal esophagus.

S3550 Not Just Another Food Bolus: Large Cell Neuroendocrine Carcinoma of the Esophagus Presenting as Acute Esophageal Food Impaction

S3550 Not Just Another Food Bolus: Large Cell Neuroendocrine Carcinoma of the Esophagus Presenting as Acute Esophageal Food Impaction

2858 Effervescent Granules Are an Effective, and Cost-Saving Strategy in Acute Esophageal Food Impaction

INTRODUCTION: Acute esophageal food impactions (AEFI) are common. Effervescent granules (EG) consist of sodium bicarbonate and citric acid and create carbon dioxide (CO2) gas in the esophagus, which can raise the intraluminal pressure and force the bolus into the stomach. There are little published data describing EG in the treatment of AEFI. The primary purpose of this study was to evaluate the effectiveness and safety of EG in the emergency department (ED) setting in adult patients presenting with AEFI. Secondary objectives are to determine cost associated with EG, and to see if there are any patient characteristics that may predict successful response. METHODS: A prospective chart review of patients presenting to the ED with AEFI in a large tertiary referral teaching hospital, as well as from 2 sister community hospitals in the same metropolitan area from January 1, 2016 to December 31, 2018 was performed. Inclusion criteria were age 18 and older and clinical diagnosis of AEFI. Data collected included patient demographics, outcomes, cost and complications. Mann-Whitney testing was used to compare groups. Logistic regression was used to determine predictors of effectiveness. Successful response was defined as clearance of the food impaction avoiding the need for emergent endoscopy. RESULTS: Sixty AEFI presentations met inclusion criteria with mean age of 51.0 years (+/- 18.4) and mean BMI 29.1 kg/m2 (+/- 6.6). Other demographic variables are shown in Table 1. A total of 33 patients (55.0%) who received EG responded successfully. The median hospitalization cost associated with EG success was $1,743 (IQR $976-$2,427). For patients who failed to respond to EG, the median cost was $13,224 (IQR $10.563-$18,933) (P < 0.001). Of concern, there were 2 cases of esophageal perforation that both occurred in patients who failed to respond to EG but were only noted after EGD. One healed with conservative therapy (NPO, antibiotics) and the other with placement of a covered esophageal stent. Both made a full recovery. CONCLUSION: Effervescent granules are an effective and cost-saving initial strategy in the treatment of acute esophageal food impaction. Further study of the safety and effectiveness of effervescent granules is warranted.

Glucagon for Relief of Acute Esophageal Foreign Bodies and Food Impactions: A Systematic Review and Meta-Analysis.

Glucagon is frequently used for the relief of esophageal impactions. This systematic review and meta-analysis were performed to evaluate the efficacy and safety of glucagon for acute esophageal foreign body and food impactions. PubMed, CINAHL, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched from inception to March 1, 2018. Retrospective, observational, and randomized controlled trials assessing glucagon for the relief of acute esophageal foreign body and food impaction were included. There were no language or age restrictions. Only studies conducted on humans and with a comparator (e.g., control or placebo) were included. Study quality analysis was performed using the Cochrane Risk of Bias tool. Quality of evidence analysis was performed using the Grading of Recommendations, Assessment, Development and Evaluations approach. A total of 1988 studies were identified, and five studies with a total of 1185 subjects were included. Treatment success occurred in 213 of 706 (30.2%) patients in the glucagon group and 158 of 479 (33.0%) patients in the control group (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.69-1.17, p=0.42). There was minimal statistical heterogeneity (I2 =14%, p=0.33). No publication bias was identified. Adverse events were identified in 24 (15.0%) patients in the glucagon group and 0 (0%) patients in the placebo group (risk difference [RD] 0.18, 95% CI 0.03-0.33, p=0.02). Vomiting events occurred more frequently in the glucagon group (17 of 160 [10.6%] vs 0 of 53 [0%]) but was not statistically significant (RD 0.07, 95% CI -0.03-0.17, p=0.19). Glucagon was not associated with a difference in treatment success but had a higher rate of adverse events for the treatment of esophageal foreign body and food impaction. Further controlled studies are needed to confirm the efficacy of glucagon with adequate power to assess adverse events.

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

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.

Tu1203 Effervescent Granules Are a Safe, Effective, and Cost-Saving Initial Strategy in Acute Esophageal Food Impaction

Tu1203 Effervescent Granules Are a Safe, Effective, and Cost-Saving Initial Strategy in Acute Esophageal Food Impaction

Safety and efficacy of glucagon for the relief of acute esophageal food impaction

The safety and efficacy of i.v. glucagon for the relief of acute esophageal food impaction were evaluated. The medical literature was reviewed to identify published trials and case series on the use of i.v. glucagon for the relief of acute esophageal food impaction. Individual case reports and limited case series were excluded from the analysis. This search yielded two retrospective reviews, three prospective reviews, and one randomized, placebo-controlled trial. Only two of the studies analyzed the effect of glucagon alone. Two studies combined this therapy with benzodiazepines, and the other two combined this therapy with an effervescent product and water. Of the two studies that had a control group, one demonstrated no significant difference in the success rate of dislodgement and one showed a nonsignificantly lower success rate in the treatment group. The majority of reports excluded patients with known esophageal strictures and treated a variety of different food-type impactions, making it difficult to determine if the success of this therapy may be tied to a specific subgroup. Few studies documented the adverse effects of this therapy, the most common being nausea and vomiting. Although limited, the available data do not support the use of glucagon for the relief of acute esophageal food impaction. Based on the available data, the use of i.v. glucagon for the relief of acute esophageal food impaction is not supported by the literature. In addition, glucagon has the potential to cause adverse effects and decrease the likelihood of spontaneous resolution.

Through-the-Scope, Wire-Guided Esophageal Dilation for the Treatment of Food Impaction

Acute esophageal food impaction (EFI) may be treated by endoscopic extraction of the food bolus either en bloc or in a piecemeal fashion. We have found this endoscopic extraction technique to be unsatisfactory. Our purpose was to demonstrate the use of through-the-scope (TTS), wire-guided esophageal balloon dilation to treat EFI. Case reports defining the technique and results of esophageal balloon dilation to treat EFI. Tertiary referral center. Eleven patients presenting with EFI. Through-the-scope (TTS), wire-guided esophageal balloon dilation to relieve EFI. Main outcome measurements Endoscopic resolution of EFI. TTS, wire-guided esophageal balloon dilation successfully dislodged the EFI in all 11 patients. The procedure took <5 minutes to complete in all cases. There were no major procedure-related complications. Small number of patients. We have found TTS, wire-guided esophageal balloon dilation to be a simple, quick, safe, and effective technique to treat EFI.

The use of glucagon in acute esophageal food impaction (EFI): how often does it work?

The use of glucagon in acute esophageal food impaction (EFI): how often does it work?

Retrospective analysis of the treatment of acute esophageal food impaction in a community gastroenterology practice

Retrospective analysis of the treatment of acute esophageal food impaction in a community gastroenterology practice

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction

Outcomes of acute esophageal food impaction: Success of the push technique

Background: Acute esophageal food impaction (AEFI) is the most common form of esophageal impaction in adults. The current recommendation for management is extraction by using an overtube to protect the airway, which facilitates multiple passages of the endoscope and protects the esophageal mucosa. Typically, AEFI in our patients is treated with the push technique, a method found to be highly successful and without complications. Methods: All patients with a diagnosis of AEFI from 1993 to 1998 were identified by computer search of ICD-9 diagnosis code 935.1 (foreign body of the esophagus). Patients were excluded if they were less than 18 years of age, had an acute esophageal foreign body other than food, or if the medical record was incomplete. Results: The analysis included 189 patients: 114 men and 75 women. Of these, 77 (41%) had a Schatzki's ring, 61 (32%) had an esophageal stricture, and 4 (2%) had esophageal cancer. In 47 patients (25%) no obvious structural cause for AEFI was noted at endoscopy. In addition, 67 patients had breaks in the esophageal mucosa. The push technique resolved the food impaction in 184 of 189 (97%) of the patients. In no subgroup was there an instance of perforation, aspiration, or bleeding. Forty-five patients underwent dilation at the time of food disimpaction without complication. Conclusions: The push technique is both safe and effective in the treatment of AEFI. Dilation at the initial presentation of a patient with AEFI likewise appears to be safe. The push technique is recommended as the initial therapy of choice for AEFI. Dilation at the time of esophageal food disimpaction can be considered if there are no obvious contraindications. (Gastrointest Endosc 2001;53:178-81.)

Acute esophageal food impaction treated by water-soluble contrast esophagography with maneuvers

This report describes a case of acute esophageal food impaction in the lower esophagus treated by proper physical motions during esophagography using water-soluble contrast medium (WSCM). WSCM was used to avoid the complication from unexpected perforation during the examination. Relief of esophageal obstruction may be accomplished by asking the patient to jump up and down on the ground. Esophagography using WSCM combined with appropriate physical motions may be helpful in treating patients suffering from acute esophageal food impaction.

Treatment of acute esophageal food impaction with glucagon, an effervescent agent, and water.

In 1990, we described a combination therapy that uses glucagon, an effervescent agent, and water to relieve acute esophageal food impaction. The initial trial showed relief of the obstruction in 12 of 16 cases without complication, so we continued the series to determine the safety and effectiveness of this technique. Between July 1987 and August 1993, a prospective trial consisting of 43 patients with 48 episodes of acute (less than 24-hr duration) food impaction in the distal two thirds of the esophagus were identified with either a barium or water-soluble contrast agent swallow. Subsequently, we attempted to relieve the obstruction by using 1 mg of IV glucagon, an effervescent agent, and water. A water-soluble esophagogram was obtained immediately in all cases to determine the response to the therapeutic intervention and to look for any complication such as perforation. The combination therapy resulted in the clearance of food obstruction in 33 (69%) of 48 attempts. One complication, a minor mucosal laceration, occurred after two unsuccessful treatments. A lower esophageal ring was the single most common abnormality identified (n = 24). The average width of rings in the successful cases was 15.4 mm and the average in the unsuccessful cases was 13 mm. Other underlying causes of obstruction were esophagitis and stricture. Our experience with the use of glucagon, an effervescent agent, and water to relieve acute esophageal food impaction indicates that the technique is highly successful and that serious complications are rare.

Acute esophageal food impaction following radiotherapy for patients with esophageal cancer

Acute esophageal food impaction following radiotherapy for patients with esophageal cancer

Treatment of acute esophageal food impaction with a combination of glucagon, effervescent agent, and water.

Esophageal food impaction is a common clinical problem. Various methods of treatment have been described, including the use of glucagon and effervescent agents, either alone or in combination, with various degrees of success [1 -8]. Physicians have been reluctant to use the glucagon and effervescent agents since Smith et al. [7] reported a case in which an esophageal perforation occurred after the procedure. We studied the value of combination therapy that uses glucagon, an effervescent agent, and water in the treatment of acute esophageal food impaction in i 6 cases. Our results indicate that it is an efficient, safe, and cost-effective form of therapy.

Use of glucagon and gas-forming agents in acute esophageal food impaction.

Use of glucagon and gas-forming agents in acute esophageal food impaction.

The treatment of acute esophageal food impaction.

Acute food impaction in the distal esophagus usually occurs in patients who have benign strictures, abnormal rings, esophagitis with spasm, or motility disturbances. Since a fixed fibrotic stricture or ring appears to be more common than spasm, the author advocates the administration of gas-forming agents in a first attempt to push the food into the stomach, to be followed by the intravenous administration of glucagon if results are not forthcoming. However, some patients will require endoscopic removal of the impacted food no matter what course of treatment is followed.