Esophageal Food Impaction Research Articles

S707 Differences in Clinical Presentation and Treatment Response of Patients With Eosinophilic Esophagitis Complicated by Symptoms of Esophageal Food Impaction

S707 Differences in Clinical Presentation and Treatment Response of Patients With Eosinophilic Esophagitis Complicated by Symptoms of Esophageal Food Impaction

S703 A Protocol to Manage Esophageal Food Impaction

S703 A Protocol to Manage Esophageal Food Impaction

Timing of Endoscopic Intervention for Esophageal Food Impaction and Its Impact on Patient Outcomes.

Esophageal food impaction (EFI) is a common complaint of patients presenting to the emergency department. EFI requires urgent evaluation by the gastroenterology service and often necessitates esophagogastroduodenoscopy (EGD) for management. Timing of EGD in patients with EFI that does not improve with medical management remains a point of contention. We aim to evaluate outcomes of EFI in the context of time to intervention. A retrospective cohort study was performed among patients who presented to a multicenter health system with EFI between 2018 and 2022. Patients with EFI that did not resolve after medical management and required EGD were included. Outcome analysis evaluated rates of complications and hospitalizations. Two hundred eighty sis unique patient presentations were included. 175 (61.2%) of patients underwent EGD within six hours of presentation, 59 (20.6%) underwent EGD six to twelve hours after presentation, and 52 (18.2%) underwent EGD beyond twelve hours after presentation. Complication rates did not differ between patients depending on timing of EGD (p = 1.000). Admission rates were higher among patients in whom EGD was performed longer after presentation (p = 0.003). Complication rates were higher among patients with advanced age (p = 0.037), prior impaction (p = 0.004), and those who have not received glucagon (p = 0.007). Timing of EGD after presentation in patients with EFI was not associated with a difference in complication rates. Delayed intervention was associated with a higher rate of hospitalization which should be taken into consideration when assessing the cost of EFI to the healthcare system.

Cola Saves My Life: The Successful Treatment of Oesophageal Food Bolus Impaction with Cola Ingestion

Oesophageal food bolus impaction, a serious emergency, requires immediate intervention to prevent complications, such as perforation or aspiration leading to respiratory distress. Severity varies based on factors such as the size of the ingested object, obstruction site, individual health, and the promptness of medical attention. In this report, we present the case of a middle-aged gentleman who presented to the emergency department with oesophageal food obstruction caused by a piece of lamb meat. Despite the initial unsuccessful attempts with first aid treatment, the patient experienced immediate relief of obstruction upon ingesting cola. This case highlights the potential use of cola in managing selected cases of oesophageal food impaction, offering a non-invasive alternative to oesophago-duodenoscopy. While cola emerged as a promising intervention in this case, its broader applicability and safety warrant further investigation through controlled trials. Establishing judicious cola use guidelines alongside traditional interventions can enhance patient care and safety.

Diagnosis and management of eosinophilic esophagitis and esophageal food impaction in adults : Aposition paper issued by the Austrian Society of Gastroenterology and Hepatology (ÖGGH).

This position paper deals with an expert consensus on diagnosis and management of eosinophilic esophagitis and esophageal food impaction issued by the Austrian Eosinophilic Esophagitis Network, aworking group under the patronage of the Austrian Society of Gastroenterology and Hepatology (ÖGGH). In need of astandardized approach on the management of EoE, recommendations were made based on international guidelines and landmark studies.

Performing Esophageal Biopsies Is Safe During Upper Endoscopy for Food Impaction but Are Underperformed in Certain Populations.

Despite recommendations to perform esophageal biopsies during esophagogastroduodenoscopy (EGD) for esophageal food impaction to evaluate for eosinophilic esophagitis (EoE), endoscopists often forgo biopsies. There are minimal data on the risks of biopsies in this setting. To determine the safety of performing biopsies during EGD for food impaction. We conducted a retrospective cohort study of patients who presented to University of North Carolina Hospitals from 2014 to 2021 with endoscopically confirmed food impaction. Data were abstracted from the medical records. Baseline clinical characteristics, procedural details, and adverse events were compared between patients who did and did not undergo biopsy. Adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extra-esophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Of 188 patients who underwent EGD for food impaction, 73 (39%) had biopsies taken. Older and non-White patients were less likely to be biopsied. None of the Black patients had biopsies taken. Only 2 (2.7%) of the 73 biopsied patients had an adverse event, and neither was related to the biopsies. Patients who were biopsied were less likely to experience adverse events. There were no differences in re-admission, ICU admission, or 30-day mortality between patients who were and were not biopsied. Esophageal biopsies remain underperformed during EGD for food impaction, especially in certain patient populations. Esophageal biopsies at the time of food impaction are unlikely to cause adverse events. Safety concerns should not preclude biopsies, and biopsies should be performed in the absence of extenuating circumstances.

Esophageal food bolus impaction in pediatric age.

Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children. We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation. Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication,and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food. Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.

Gastric glomus tumor mimicking neuroendocrine tumor on fine needle aspiration: a diagnostic pitfall

Abstract Introduction/Objective Glomus tumors (GT) are mesenchymal neoplasms of modified smooth muscle that most commonly affect subungual regions of distal extremities. Although they can occur everywhere in the body, gastric involvement is rare. Gastric GT is usually benign but given the overlapping morphologic and immunohistochemical features with other gastric mesenchymal tumors, GT is commonly misdiagnosed. Methods/Case Report We present two cases of gastric GT initially diagnosed as well-differentiated neuroendocrine tumor (WDNT), G1 on fine needle aspiration (FNA). A 57-year-old female presented with an incidental 1.5 cm gastric submucosal lesion discovered on endoscopy performed for esophageal food impaction. The second case is of a 73- year-old male with a 1.7 cm submucosal lesion found on endoscopy for reflux. Both lesions were located in the gastric antrum. FNA showed clusters of relatively uniform cells with moderate cytoplasm, round nuclei, and stippled chromatin. Tumor cells were focally positive for synaptophysin, while negative for CK7, CD117, DOG-1, and chromogranin. Ki-67 proliferative index was <3%. A diagnosis of WDNT, G1 was made. Subsequent partial gastrectomy showed a submucosal epithelioid neoplasm composed of cells with eosinophilic to clear cytoplasm, and distinct cellular membranes. Focally dilated, tumor-associated thin-walled vessels were noted. Immunohistochemically, the tumor was positive for SMA, calponin, and synaptophysin, and negative for CK AE1/AE3 and chromogranin, supporting the diagnosis of gastric GT. Results (if a Case Study enter NA) N/A Conclusion The rarity of gastric GT, combined with the morphological and immunohistochemical similarity with WDNT, led to diagnostic pitfalls in these cases. With the increased detection and sampling of incidental gastric lesions, cytopathologists should be aware of this uncommon tumor and its mimics, and as such, expand their differential diagnoses.

Association between time from esophageal food impaction to endoscopy and adverse events

Guidelines recommend emergent or urgent EGD for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We determined whether EFI-to-EGD time was associated with adverse events. In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extraesophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extraesophageal adverse events requiring intensive care unit admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events. Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older and more likely to have an esophageal motility disorder, to tolerate secretions at presentation, and to have a higher American Society of Anesthesiologists score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (odds ratio, 1.00 [95% confidence interval, .97-1.04] for 1-hour increments; odds ratio, 1.03 [95% confidence interval, .86-1.24] for 6-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders. Because the time from EFI to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary, and other considerations may determine EGD timing.

Effect of Delayed Endoscopy Protocol on Timing and Safety of Endoscopy for Foreign Body Ingestion and Esophageal Food Impaction.

Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours. Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021. We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8d P<0.001), day cases (0.16 vs. 1.0d P<0.001), and night cases (0.40 vs. 0.6d P=0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% (P=0.01). This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.

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

S454 Performing Esophageal Biopsies During Upper Endoscopy for Esophageal Food Impaction Is Unlikely to Cause Complications

S454 Performing Esophageal Biopsies During Upper Endoscopy for Esophageal Food Impaction Is Unlikely to Cause Complications

Comparable Efficacy for Push VersusPull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis.

Esophageal food impaction (EFI) is a common GI emergency. Push and pull methods are used currently for EFI retrieval. We aim to review current available literature to compare success rates and evaluate adverse event rates of the two techniques. A comprehensive literature search was performed using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, SciELO and Global Index Medicus. Odds ratio (OR) with 95% confidence interval (CI) was calculated when comparing the dichotomous variables. We aimed to evaluate technical success and adverse events for EFI comparing push and pull technique on single arm and comparator analysis. The search strategy yielded a total of 126 articles. 18 studies with 3528 participants were included. The technical success rate was 97.5% (CI 96.6-99.2%) in the push and 88.4% (CI 72.8-98.7%) in the pull technique with no statistical difference on comparator analysis. Overall rate of adverse events was 4.03% (CI 0.9-5.0%) in the push technique and 2.22% (CI 0-2.9%) in the pull technique with no statistical difference on comparator analysis (OR 95% CI 0.464-2.782, p = 0.78, I2 = 31.54%). There was no statistical difference between rate of lacerations and perforations either between the two techniques. Both techniques have acceptable clinical outcomes which appear within standard of care. Operator experience and individual clinical scenarios should guide decision-making regarding technique selection.

Enhanced suction for removal of esophageal food impaction.

Video 1Enhanced suction for removal of esophageal food impaction.

A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy

BackgroundEmergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. Case ReportWe discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. Why Should an Emergency Physician Be Aware of This?This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.

Diagnosis of Eosinophilic Esophagitis at the Time of Esophageal Food Impaction.

Esophageal food impactions (EFI) often precede a diagnosis of eosinophilic esophagitis (EOE). Current guidelines suggest obtaining esophageal biopsies upon suspicion of EOE, treating with proton pump inhibitor (PPI), and repeating esophagogastroduodenoscopy (EGD). This study was conducted to determine provider practice patterns with these mentioned recommendations at the time of EFI. In this retrospective study, key outcomes were the proportion of patients who had EOE mucosal biopsies, EOE diagnosis, PPI initiation, and recommendations and completions of repeat EGD. Differences in outcomes among age, sex, race, off-hours time of procedure, and trainee involvement were examined. EOE diagnosis predictors were explored with logistic regression. Twenty-nine percent of the patients had esophageal biopsies taken at the time of index EGD (iEGD). Sixteen patients were diagnosed with EOE at the time of index EFI, while fourteen patients were diagnosed on subsequent EGDs. Among those diagnosed with EOE at iEGD, 94% were placed on PPI. Of patients with confirmed EOE on index biopsy, 63% of patients were recommended repeat EGD, of which 50% completed it within 90 days. Older age was protective of EOE diagnosis while no GERD history and endoscopist suspicion of EOE predicted diagnosis of EOE. Endoscopists uncommonly take biopsies at the time of EFI, which may delay diagnosis and treatment of EOE.

Nursing of an elderly patient with esophageal food impaction during the recovery stage after cerebral infarction

Nursing of an elderly patient with esophageal food impaction during the recovery stage after cerebral infarction

Eosinophilic oesophagitis – symptoms, diagnosis and treatment

Eosinophilic oesophagitis is a complex multifactorial disorder and one of the leading causes of dysphagia in children and adults. An allergen-mediated inflammatory response is the underlying cause of this disease. Allergen-activated Th2 cells, eosinophils and interleukins 4, 5 and 13 play a major role in the pathogenesis of eosinophilic oesophagitis. Difficulties swallowing, especially dry food, and the related increase in chewing time, as well as episodes of oesophageal food impaction, often requiring endoscopic treatment, are the leading symptoms. Children develop nausea, vomiting, abdominal pain, irritability and reluctance to consume foods. The incidence of eosinophilic oesophagitis has increased dramatically in recent years and is now estimated at approximately 42.2/100,000 per year in adults. Endoscopy followed by histopathological examination of at least six biopsy specimens taken from two different sections of the oesophagus is the gold diagnostic standard. The eosinophilic oesophagitis endoscopic reference score (EREFS) is used for endoscopy and the eosinophilic oesophagitis histologic scoring system (EoE HSS) is used for histopathology to objectify the assessment. Pharmacological and dietary therapies are of primary importance in eosinophilic oesophagitis. Proton pump inhibitors and glucocorticoids are most commonly used. Allergen-free diets significantly contribute to the achievement of permanent histological and clinical remission. In the case of permanent oesophageal remodelling, endoscopic and/or surgical treatment should be considered.

Esophageal Food Impaction and Foreign Object Ingestion in Gastrointestinal Tract: A Review of Clinical and Endoscopic Management

Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three years of age. Food impaction is mostly encountered among adults with different pathologies. For the removal of swallowed foreign bodies, digestive endoscopy is the gold standard method, being successful in over 95% of cases without significant complications. For the endoscopic management of foreign bodies, it is crucial to be aware of the indications, devices, techniques and patient preparation in order to achieve successful and safe removal from the digestive tract. Recommendations in this article are based on a review of the literature and extensive personal experience.

An unusual case of meat bolus impaction in an adult

Esophageal food impaction is a common emergency faced by ENT surgeons and gastroenterologists. It is important to know what techniques and instruments are indicated for different situations. Endoscopic treatment is a reliable and safe procedure in skilled, expert hands with a high success rate and low morbidity and mortality.