Esophageal Food Bolus Research Articles

P9: MANAGEMENT OF ESOPHAGEAL FOOD BOLUS OBSTRUCTION AT A UNIVERSITY TEACHING HOSPITAL – A RETROSPECTIVE ANALYSIS

Abstract Introduction Despite the fact that esophageal food bolus obstruction is a common surgical problem, there are no clear guidelines on its management. Medical treatment with Buscopan and Glucagon is mostly in-effective, requiring a therapeutic Oesophago-Gastro-Duodenoscopy (OGD). Method All consecutive cases of food bolus obstructions (FBO) presenting to the Emergency Department (ED) for 18 month period between 01/01/2018 and 30/06/2019 were retrospectively reviewed. Result A total of 30 patients were admitted with food bolus obstruction via ED (1.67 per month). Females (67%) constituted most of these patients. Average age was 55 with range of 19-83. 84% of patients presented with Dysphagia, while Odynophagia (10%) and chest pain (6%) were other presenting symptoms. Average duration of symptoms was 17 hours (Range 2 – 48 hours). 44% of patients had OGD done under sedation while others (56%) had under General Anaesthesia (GA). In 70% of cases, food bolus was pushed into stomach, while it was retrieved out in 20%. In 10%, it had already spontaneously passed in stomach on OGD. The etiology of FBO was inflammatory in 60% cases, while an esophageal stricture was seen in 10% only. In 30% cases no cause of FBO was identified. Post-OGD length of stay was on average 1.15 days (range 12 hours – 7 days). 2 patients had aspiration pneumonia prolonging their hospital stay, there was no esophageal perforation or mortality. Conclusion Esophageal food bolus obstruction is a common surgical problem, OGD under GA is a safe recommended procedure, which often picks up an underlying pathology. Take-home message Esophageal food bolus obstruction is a common surgical problem, OGD under GA is a safe recommended procedure, which often picks up an underlying pathology.

Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process

Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.

Frequency of Patients Passing an Impacted Esophageal Meat Bolus by Conservative Method Alone

Objectives: To determine the frequency of patients passing the impacted esophageal meat bolus by conservative management Methods: After obtaining permission from ethical committee of Hospital,a total of 62 patients meeting the study criteria were recruited in the study which was conducted in Department of Otorhinolaryn-gology, Services Hospital, Lahore. Demographic information (name, age, gender, contact) was also obtained. Patients with clinical suspicion of impacted esophageal food bolus of age 20-50 years of either gender were included. Patients with known esophageal abnormalities like stricture, web or growth on either barium swallow or esophagogastroduodenoscopy, peptic ulcer and GERD were excluded. After taking informed written consent from each patient, single intravenous dose of buscopan 20mg was given to each patient. Each patient was followed by the researcher himself for 24 hours to assess the passage of food bolus. Results: 20-50 years was the age range in our study, with mean age being 34.10± .63 years. Majority of the patients 32 (51.61%) were between 20 to 35 years of age. Out of 62 subjects, 37 (59.68%) were male, 25 (40.32%) were females with male to female ratio 1.5:1. In our study, Frequency of patients passing the impacted esophageal meat bolus by conservative management was found in 51 (82.26%) patients. Conclusion: This study concluded that there is a high frequency of patients passing the impacted esophageal meat bolus by conservative management. Keywords: Esophagus, foreign body, conservative management.

S0408 Esophageal Food Bolus Impaction and the Missed Opportunity to Diagnose and Manage EoE

INTRODUCTION: Esophageal food impaction may be the initial presentation for patients with undiagnosed eosinophilic esophagitis (EoE). These acute encounters offer physicians an opportunity to biopsy and potentially diagnosis the condition. Though prior studies are limited, they have shown patients presenting with food impaction are often not biopsied and have high inadequate follow-up. This creates concerns that patients are undertreated and at risk for future complications. We aim to augment and expand on prior studies by examining follow-up, treatment recommendations, and other EGD findings in patients presenting with acute food bolus impaction. METHODS: We conducted an IRB approved retrospective chart review at a tertiary medical center of patients presenting with esophageal food bolus removed by EGD. Exclusion criteria were esophageal blockage not due to a food bolus, patients with prior established diagnosis of EoE, and patients with other etiologies for food impaction including: esophageal cancer, external compression of the esophagus, or underlying esophageal dysmotility. Over a 3-year period, 134 EGD’s were performed for food bolus impaction with 100 patients ultimately meeting inclusion and exclusion criteria. Categorical data was analyzed using the Chi-Square test while quantitative data was analyzed with the t-test. RESULTS: Our patients were 68% male, 93% Caucasian, and an average age of 62 years. 84% had a follow-up scheduled, but only 49% of total patients followed-up. Only 28% of the patients were biopsied at the time of food bolus impaction. Patients who didn't receive a biopsy were less likely to be given treatment recommendations (7.1% vs. 31.9%, P = 0.011) and more likely to have subsequent food bolus impactions (13.9% vs 0%, P < 0.039). Patients who were younger (54 years vs. 65.7 years) and had gross findings suggestive of EoE (46.2% vs. 15.3%) were also more likely to receive a biopsy. CONCLUSION: Our study suggests that patients presenting with a food impaction of unknown etiology should receive an esophageal biopsy during that initial encounter to exclude EoE. Many patients with EoE do not have typical findings of EoE on gross inspection. Without biopsy, numerous patients will go undiagnosed and be lost to follow-up placing them at risk for future complications. Currently, no guidelines establish clear guidance on this matter. In addition, methods to improve follow-up adherence in these patients may be beneficial.Table 1.: Follow-up and Biopsy

S0352 Endoscopic Biopsies During Presentation for Esophageal Food Impaction: An Important Opportunity for Timely Diagnosis of Eosinophilic Esophagitis

INTRODUCTION: Esophageal food impaction (EFI) is a common initial presentation of eosinophilic esophagitis (EoE). Patients presenting with EFI requiring endoscopic intervention present an opportunity to obtain esophageal biopsies to evaluate for EoE and optimize diagnostic yield before initiation of empiric treatment. We aimed to evaluate practices of esophageal biopsy at time of EFI at our institution and identify missed opportunities to diagnose EoE. METHODS: We performed a single center retrospective chart review on a subset of adult patients from 10/2015 -1/2020 who presented to NYU Langone Health with EFI. Patients who underwent upper endoscopy (EGD) and were found to have a retained esophageal food bolus were included. Those with prior diagnosis of EoE were excluded. Proportions were compared using Chi-square or Fisher’s exact test, and rank sum tests were used to compare continuous variables. Logistic regression was used to assess factors associated with subsequent need for diagnostic EGD. RESULTS: 123 patients with EFI were reviewed, 50 (40.7%) were biopsied at the time of EGD (Table 1). Among those biopsied, a new diagnosis of EoE was found in 52%. Of the patients who did not undergo biopsy at index EGD, 23% underwent repeat EGD at our institution and were found to have a new EoE diagnosis. Biopsies performed during EGD for EFI did appear to decrease the need for repeat procedure (OR 0.63, 95% CI 0.25-1.63), although not statistically significant. Patients with furrows were more likely to be biopsied however the report of other classic endoscopic features of EoE (such as exudates, ring, stricture, edema), was not significantly associated with the rate of biopsy (Table 2). Time of procedure and history of prior EFI also did not appear to influence rate of biopsy. CONCLUSION: Biopsy at the time of EFI is important to obtain a timely diagnosis of EoE. At our center, less than half of patients were biopsied at time of initial EGD for EFI, and over half of those biopsied were diagnosed with EoE. The diagnosis of EoE was missed in 23% patients who were not biopsied at time of EFI, and on subsequent EGD with biopsy were found to have EoE. This delay in biopsy likely leads to unnecessary EGDs and more patients who are unaware of their diagnosis. Future educational initiatives aimed at GI providers are needed to improve rates of biopsies during initial EGD for EFI to reduce the need for additional diagnostic procedures.Table 1Table 2

S0381 Incidence and Seasonal Variation of Food Bolus Impaction in Patients With Underlying Eosinophilic Esophagitis

INTRODUCTION: Eosinophilic Esophagitis (EoE) is a chronic disorder of the esophagus characterized as a condition with esophageal symptoms such as dysphagia and an identifiable eosinophilic infiltrate on biopsies in the absence of other etiology. Studies into the reason for the recent rise in incidence and prevalence have discussed the environmental factors that may be associated with the disorder with the pathogenesis thought to be a combination of inflammatory and allergy mediated. In this setting, reports have found that cases can be provoked by aeroallergens and the observation of seasonal variation and geographic variation in presentation. The primary aim of this study was to search for a potential seasonal variation in the presentation of esophageal food bolus impaction in patients with EoE. METHODS: A retrospective analysis of endoscopies completed from May 2017 through April 2019 for foreign body removal or with food found in the esophagus was performed. The study identified a total of 177 cases with 19 cases of esophageal food bolus impaction in patients with established or newly identified EoE. Cases were analyzed regarding seasonal variation in incidence of food bolus impaction and demographic data and variables such as eosinophil count on biopsy and level of impaction were also analyzed using Fisher’s exact test. RESULTS: The overall incidence of esophageal food impaction in cases of EoE was higher in the winter with 10/19 (52.6%) of overall cases occurring in winter compared to 3/19 (15.8%) in other seasons although this did not reach statistical significance (P = 0.0561). 63.2% of the patients were male and 89.5% were white. The difference in eosinophil count and level of impaction did not significantly vary by season (P = 0.5885 and 0.4250). There were four observable strictures found in the group. CONCLUSION: In our study there was a higher incidence of food impaction in the winter season but this did not reach statistical significance. No difference was found in the magnitude of the eosinophilic infiltrate in biopsy specimens by season or by level of impaction. Previous studies have had differing findings on the role of aeroallergens in the pathophysiology and presentation of EoE as well as the presence of seasonal variation and the specific season. Due to these varied findings and small numbers in our study, ongoing evaluation is warranted to shed further light on the presence of possible seasonal variation and the impact environment has on EoE.Figure 1.: Esophageal Food Impaction by Season (P = 0.0561).Figure 2.: Eosinophil Count by Season.Figure 3.: Level of Impaction by Season (P = 0.4250).

Is an X-ray a Useful Test for Esophageal Food Boluses? A Case Report.

Plain film, esophageal food bolus impaction, esophagitis, esophageal dysmotility, obstruction.

Conservative management of oesophageal soft food bolus impaction.

Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. We used standard methodological procedures recommended by Cochrane. We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.

Protocolo diagnóstico de la sensación de globo esofágico

Oesophageal or pharyngeal food bolus obstruction is described as a feeling of tightness or obstruction in the throat. Up to half of the population report compatible symptoms at some point in their life, symptoms that are a frequent reason for consultation. Identifying the underlying cause can be complicated, and even though it is a recognised functional disorder, organic causes should be first ruled out. In the absence of obstructive causes, gastro-oesophageal reflux disease is considered the most common organic cause. The most relevant complementary tests for studying globus pharyngeus are nasal endoscopy, high gastrointestinal endoscopy, pH-metry and high-resolution manometry. Despite the generally benign character of the symptoms, they can entail a significant reduction in the quality of life.

AB195. Management of esophageal food bolus obstruction at a university teaching hospital—a retrospective analysis

AB195. Management of esophageal food bolus obstruction at a university teaching hospital—a retrospective analysis

A152 FOREIGN BODY INGESTIONS AT A TERTIARY CARE CENTRE - A QUALITY ASSURANCE STUDY

Abstract Background Foreign body ingestion and esophageal food bolus impaction are common emergencies encountered by gastroenterologists. If not treated in a timely fashion these can result in significant morbidity, or even mortality. The mainstay of diagnosis and therapy is endoscopy. Guidelines regarding timing of endoscopy have been published by both the American and European Societies of Gastrointestinal Endoscopy, and both suggest emergent endoscopy, meaning within 2 to 6 hours, for complete esophageal obstructions. There is relatively sparse data regarding the endoscopic techniques used in real world practice. Aims This is a quality assurance study looking at the endoscopic practices at an adult tertiary care hospital in Halifax, Nova Scotia with respect to foreign body and food impaction management. Methods The hospital records of all patients presenting with ingested foreign bodies or esophageal food bolus impactions between May 2018 and July 2019 were included. Patients were identified by searching the call-back forms used by our department which documents all on-call endoscopy cases. This was then cross-referenced by endoscopy nursing charting which documents every endoscopy performed. Information such as demographics, obstruction type, endoscopic method of removal, complications, time between consultation and endoscopy, underlying pathology, and others were analyzed. Results 70 cases were identified. Average patient age was 51.3 years old (range 16–96). 18 (25.7%) were female and 52 (74.3%) were male. 64 cases (91.4%) were esophageal food impactions and 6 (8.57%) were foreign body ingestions. Of the food impactions, 39 cases (60.9%) were cleared by the push/slide-by technique only and 10 (16.7%) were relieved using instruments such as snares, forceps, or nets. 15 (23.4%) passed spontaneously prior to scope, of which 7 received glucagon. An overtube was used in 1 case (0.16%). Complications occurred in 5 (7.8%) cases and included 3 mucosal tears, 2 of which required therapeutic interventions, and 2 episodes of oxygen desaturation in which the procedure was aborted. Complete obstructions occurred in 42 (65.6%) cases with average time of consultation to endoscopy of 2.4 hours. However, 3 (7.1%) cases exceeded 6 hours. The most common pathology was eosinophilic esophagitis with 20 cases (31.3%). Ingested foreign bodies included 2 long objects, 3 sharp objects, and a cylindrical battery, and all but one were in the stomach. 5 (83.3%) cases used an overtube. No complications occurred. Conclusions At our institution 67/70 (95.7%) cases were performed within the timelines recommended by society guidelines. No complications occurred in the cases not performed within those time limits. An overtube was used in only one case in which a food bolus was retrieved out of the esophagus. Overall this study suggests that our centre is meeting recommended targets, however there is room for improvement. Funding Agencies None

Immediate dilation in esophageal food impaction is safe and effective but performed infrequently: observations from a large Midwest US cohort.

This study aimed to determine the rate and safety of immediate esophageal dilation for esophageal food bolus impaction (EFBI) and evaluate its impact on early recurrence (i.e. prior to interval esophageal dilation) from a large Midwest US cohort. We also report practice patterns among community and academic gastroenterologists practicing in similar settings. We identified adult patients with a primary discharge diagnosis for EFBI from January 2012 to June 2018 using our institutional database. Pregnant patients, incarcerated patients, and patients with esophageal neoplasm were excluded. The primary outcome measured was rate of complications with immediate esophageal dilation after disimpaction of EFBI. Secondary outcomes were recurrence of food bolus impaction prior to scheduled interval endoscopy for dilation, practice patterns between academic and private gastroenterologists, and adherence to follow-up endoscopy. Two-hundred and fifty-six patients met our inclusion criteria. Esophageal dilation was performed in 46 patients (18%) at the time of disimpaction. A total of 45 gastroenterologists performed endoscopies for EFBI in our cohort. Twenty-five (62%) did not perform immediate esophageal dilation, and only 5 (11%) performed immediate dilation on greater than 50% of cases. Academic gastroenterologists performed disimpaction of EFBI for 102 patients, immediate dilation as performed in 20 patients and interval dilation was recommended in 82 patients. Of these 82, only 31 patients (38%) did not return for interval dilation. Four patients who did not undergo immediate dilation, presented with recurrent EFBI prior to interval dilation, within 3 months. None of the patients had complications. Complications with immediate esophageal dilation after disimpaction of EFBI are infrequent but are rarely performed. Failure of immediate dilation increases the risk of EFBI recurrence. Given poor patient adherence to interval dilation, immediate dilation is recommended.

412 Effervescent Granules for the Treatment of Esophageal Food Bolus Obstruction

INTRODUCTION: Esophageal food bolus obstruction is a common GI emergency without effective medical therapy, often requiring costly emergent endoscopy (EGD) for food bolus clearance. This case-control study compared the efficacy of standard of care treatment with the use of effervescent granules (sodium bicarbonate, citric acid, simethicone) for the treatment of esophageal food bolus obstructions. METHODS: Adult patients were recruited from three emergency rooms in a community-based, regional hospital system. A retrospective cohort treated with the standard of care, consisting of glucagon and/or lorazepam and/or IV fluids, was compared with a prospective cohort treated with effervescent granules. The primary end point was efficacy between the two treatment groups. RESULTS: From January 2018 – August 2018, 21 patients met the inclusion criteria for the retrospective arm and were treated with the standard of care; from September 2018- April 2019, 33 patients met the inclusion criteria and were treated with effervescent granules for esophageal food bolus obstructions. 3 out of 21 patients from the retrospective arm and 20 out of 33 patients from the prospective arm had successful food bolus clearance without requiring an EGD (success rate = 14.3% vs. 60.6%; P = 0.002.) There was one complication of a Mallory-Weiss tear noted on endoscopy without clinical significance in a patient treated with effervescent granules. The percentage of males was slightly higher in the prospective arm (22 males, 66.7% vs. 10 males, 47.6%; P = 0.27), and patients were slightly younger in the prospective arm (mean = 55.8 years, standard deviation (SD) = 16.8 vs. mean = 64.6, SD = 20.4; P = 0.11.) CONCLUSION: Treatment of esophageal food bolus obstruction with effervescent granules is more efficacious than the standard of care, with no clinically significant complications. Effervescent granules should be further studied as a safe and effective medical treatment option for this common GI emergency.

428 Esophageal Food Bolus Impactions: Predictors of Persistent Impaction at Endoscopy and Strategies for Disimpaction

INTRODUCTION: Esophageal food bolus impaction is a true gastrointestinal emergency. While most cases resolve spontaneously, up to 20% require emergent upper endoscopy (EGD). No prior studies have been done in the United States to explore how patient symptoms may predict persistent obstruction at the time of endoscopy. Our aim was to determine symptoms that reliably predict complete impaction in efforts to quickly recognize those who need emergent EGD at time of presentation. METHODS: This is a retrospective cohort study of 83 patients who presented to the emergency room with suspected food bolus impaction between 1/2013 and 5/2018 at a tertiary care academic medical center. Electronic health records were reviewed to determine presenting symptoms and initial treatment course. Exclusion criteria were age &lt; 18, history of esophageal malignancy, or presence of an esophageal stent. Descriptive statistics, univariate and multivariate analysis were performed. RESULTS: During the study period 52 of 83 (63%) patients underwent an EGD for suspected food bolus impaction. Patients who underwent EGD were more likely to have received glucagon (P = 0.004) and to have presented with sialorrhea (P = 0.001), as compared to patients who did not undergo EGD. 42 of 52 (81%) patients who underwent EGD had an overt food bolus impaction identified. Predictors of overt impaction at EGD were glucagon administration (P = 0.02), underlying esophageal pathology (P = 0.01), and sialorrhea on presentation (P = 0.01). 30 of 42 (71%) patients with overt food impaction were found to have complete obstruction. These patients were more likely to have received glucagon (P = 0.04), have an earlier EGD (P = 0.04), and have symptoms of odynophagia (P = 0.003), sialorrhea (P = 0.001), and regurgitation (P = 0.006), as compared to patients with partial obstruction. On multivariate analysis, sialorrhea (P = 0.001) and odynophagia (P = 0.023) were symptoms predictive of EGD, and only sialorrhea (P = 0.01) was predictive of persistent food impaction at EGD. CONCLUSION: Sialorrhea and glucagon administration were independently associated with the need for EGD during admission. Sialorrhea was the only symptom predictive of persistent impaction found on EGD. Sialorrhea along with odynophagia were most predictive of complete obstruction as compared to partial. These symptoms on presentation may help triage patients in need of more emergent EGD.

430 Esophageal Food Bolus Impactions Are More Likely to Occur During the Weekends

INTRODUCTION: Esophageal food impaction is a commonly encountered clinical scenario that may warrant emergent intervention, but epidemiological studies are lacking. No major studies have examined the inpatient prevalence of food impaction during the weekend. Therefore, the aim of our study is to assess the inpatient prevalence of food impaction during the weekend compared to week days. METHODS: Case-control study using the NIS 2016, the largest public inpatient database in the US. All patients with ICD10CM codes for food bolus impactions were included. None were excluded. The primary outcome was determining the odds of food bolus impaction during the weekend days as compared to the weekdays. Secondary outcomes included determining rates of esophageal perforation, hospital costs, charges and length of stay (LOS) when comparing admissions during a weekend to admissions during a weekday. Multivariate regression analyses were used to adjust for age, gender, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status. RESULTS: 7,025 patients with food bolus impaction were identified. 2,475 underwent emergent EGD (within 24 hours) and 1,935 were admitted during the weekend. Mean patient age was 66.7 years (47.9% were female). Primary outcome: after adjusting for confounders, patients admitted for food impaction displayed significantly higher odds of admission during the weekend days (aOR:1.5, P &lt; 0.01) when compared to the weekdays. No significant difference in esophageal perforation was observed between the two cohorts. Patients admitted during the weekend displayed lower hospitalization costs compared to patients admitted during the weekdays (aMean: -$1,756, P = 0.02), but no differences in hospitalization charges or length of stay were observed. All outcomes are displayed in Table 1. CONCLUSION: The odds of being admitted for esophageal food impaction are higher on weekends than weekdays. There are no different odds of esophageal perforation. This may be reflecting the previous studies demonstrating increased odds of food impaction during leisure times, as weekends in the US are often reserved for leisure activities rather than work. Interestingly, patients admitted during the weekend actually have lower adjusted mean hospital costs. This may suggest that these patients are likely admitted for observation or stay longer periods of time in the ED and hence do not generate the same hospital bill as an admission.

Oesophageal food bolus obstruction and eosinophilic oesophagitis.

Eosinophilic oesophagitis (EoE) is now a well-recognised cause of dysphagia and food bolus obstruction (FBO). The diagnosis requires histologic confirmation, and the yield is greatest when at least 4 to 6 oesophageal biopsies are taken from different sites. Previous case reports of FBO have demonstrated a low biopsy rate, and as such cases of EoE may have been missed. In this review, the medical records of 123 patients aged 18 years or older, who had presented with FBO over a 2 year period, were reviewed. EoE was the most common diagnosis, and was found in 81.3% of patients with FBO aged 40 years or less. 45.5% of patients with FBO were biopsied, and of those, 33.9% were confirmed to have had at least 4 biopsies. EoE is a common cause of FBO and requires appropriate oesophageal sampling to confirm the diagnosis. Cases of EoE may otherwise be missed.

Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study.

Background/AimsFood bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods. MethodsThis prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques.. ResultsThe study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001). ConclusionsCap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures.

Mo1238 NATURAL HISTORY, MANAGEMENT AND OUTCOMES OF ESOPHAGEAL FOOD BOLUS OBSTRUCTION

Esophageal food bolus obstruction (EFBO) is a common presenting problem to emergency departments worldwide. There is a paucity of data relating to efficacy of pre-endoscopic and endoscopic management resulting in a wide variety of clinical practice. Consensus guidelines do not advocate strongly for pre-endoscopic medications however they remain commonly used.

Tu1137 SINGLE CENTER EXPERIENCE WITH ESOPHAGEAL FOOD BOLUS IMPACTIONS: CLINICAL PREDICTORS OF COMPLETE IMPACTION AND STRATEGIES FOR DISIMPACTION

Esophageal food bolus impaction is a commonly encountered condition by gastroenterologists worldwide. No studies to date have been done in the United States to explore how history and patient symptoms may predict persistent obstruction, whether complete or partial, or passage of the food bolus at the time of endoscopy. The aims of this study are 1) to determine reliable clinical symptoms that may be predictors of complete impaction and 2) to evaluate which instruments are most commonly used and lead to the highest success rates for removal of an obstructing food bolus.

Mo1185 ESOPHAGEAL DILATION AT THE TIME OF FOOD BOLUS DISIMPACTION IS SAFE AND EFFECTIVE BUT INFREQUENT, OBSERVATIONS FROM LARGE MIDWEST US COHORT

Esophageal food bolus impaction (EFBI) is common medical emergency for gastroenterologists. Incidence of EFBI is likely to increase along with the prevalence of gastroesophageal reflux disease and eosinophilic esophagitis (EOE). As per current clinical practice guidelines, esophageal dilation after food bolus disimpaction is safe in most cases. However, in clinical practice, many forego dilation at the time of disimpaction due to concerns of esophageal perforation. It is a common practice to repeat endoscopy in 4-8 weeks for interval dilation, adding the cost of additional endoscopy. Here, we report the largest cohort of food bolus impaction to date and assess the safety of dilation at the time of disimpaction and recurrence of EFBI prior to scheduled interval dilation.