Food Bolus Impaction Research Articles

Re-inventing the probang?

I was intrigued to read of Dr Porter's exploits (Anaesthesia 1998; 53: 313–4) in removing an impacted food bolus from the laryngeal pharynx of an unfortunate woman. Had this woman's mishap occurred at sea in the 1950s (or even earlier no doubt) the ship's doctor or the first mate would have been able to consult the Ship's Doctor's Medical Guide and seen that the Board of Trade insisted on including a probang in the medical toolkit. This ‘catheter’ had a folded wire cage at the distal end. It could be passed beyond the offending impacted food, the cage expanded by a wire at the proximal end (in the way that an umbrella can be opened), and the obstruction in the lumen of the gullet removed as the probang was withdrawn. The original probang, an older version of the Board of Trade model and Dr Porter's urethral catheter, dates from 1657, when it was invented by a man called Provang [1]. It is described as a long strip of whalebone, with a sponge, ball or button at the end, for introducing into the throat to apply a remedy or remove a foreign body. Clearly Dr (Mr) Provang was in the forefront of anaesthesia in the 1650s together with that famous astronomer, Sir Christopher Wren, who described the intravenous injection of tincture of opium (in a dog) during the same decade [2].

Acute food bolus impaction: aetiology and management.

A prospective study into the aetiology of acute food bolus obstruction (AFBO) was carried out on 17 consecutive patients who presented with this complaint. There were nine males and eight females. Twelve patients (71 per cent) had symptoms of oesophageal disease and 10 patients (59 per cent) had prior food bolus obstruction. Investigations included endoscopy, barium swallow, oesophageal pH and manometry studies. Evidence of oesophageal pathology was found in 12/14 (86 per cent) of patients investigated. No patients had malignancy and the most common abnormality, gastroesophageal reflux (GOR) was found in eight out of 14 (57 per cent) of cases. Oesophageal dysmotility was seen in five out of 12 (42 per cent) patients who had manometric studies. With such a high incidence of recurrence of AFBO, we suggest that patients with this condition be investigated to exclude malignancy and to identify benign oesophageal pathology using techniques such as oesophageal pH and manometry. Appropriate treatment of oesophageal disease may help prevent recurrence of this distressing condition.

Management of ingested foreign objects and food bolus impactions

Management of ingested foreign objects and food bolus impactions

Guideline for the Management of Ingested Foreign Bodies

This guideline is intended to aid the endoscopist in the management of adult patients with possible foreign object ingestion and/or food bolus impaction. A literature search was performed on the Medline using Medlars II, the National Library of Medicine's National Interactive Retrieval Service. This search generated 181 citations. References chosen for review were English-language citations from the gastroenterology, otolarygology, general surgical, and radiological literature. As little or no data exist from well-designed prospective trials, emphasis was given to results from large series, and reports from recognized experts. In preparing this guideline several drafts were distributed to the members of the ASGE Standards of Practice Committee, to the practice committees of the AGA, ACG, and SAGES, and to national experts on this subject for critical review. A final draft was then reviewed by the ASGE Governing Board. The final guideline reflects the input from this review process.

Nitinol Prostheses for the Treatment of Inoperable Malignant Esophageal Obstruction

This uncontrolled prospective study was undertaken to evaluate a new nitinol stent in the treatment of dysphagia due to inoperable malignant esophageal obstruction. Eighteen consecutive patients (15 men, three women; mean age, 66 years +/- 15) with inoperable malignant obstructions of the esophagus or esophagogastric junction due to esophageal carcinoma (n = 14) or extrinsic obstruction (n = 4) were treated with self-expanding nitinol endoprostheses (diameter, 18 mm). Dysphagia score and activity index were assessed before and every 4 weeks after stent insertion. Eighteen stents were deployed successfully. One stent expanded insufficiently and was removed inadvertently during retrieval of the application system. Mean time until complete expansion of the stent was 7.1 days +/- 5. Stent placement resulted in a significant decrease in the dysphagia score (2.7 +/- 0.7 before vs 0.6 +/- 0.7 after stent placement, P < .00005 by Wilcoxon matched-pairs test) and a significant increase in the activity index (2.6 +/- 1 before vs 1.7 +/- 0.9 after stent insertion; P < .005). There were no procedure-related complications. Follow-up period (mean, 155 days +/- 100) revealed recurrent dysphagia in four patients. Two patients experienced food bolus impaction, another two had tumor ingrowth through the mesh after 170 and 186 days. Fourteen patients died after a mean survival time of 158 days +/- 106, all with patent stents. Self-expanding nitinol esophageal stents are safe and effective in the treatment of malignant esophageal obstructions.

Palliative intubation for dysphagia in patients with carcinoma of the esophagus

One hundred seven consecutive patients seen over a 6-year period with dysphagia secondary to advanced primary carcinoma of the esophagus underwent intubation. One hundred five patients underwent pulsion intubation. In 2 patients pulsion intubation was not possible, and laparotomy and traction intubation was performed. For the intubated group there were 65 men and 40 women (ratio, 1.6:1), with a mean age of 71.3 ± 10.5 years (range, 36 to 92 years). Of the 105 patients who had pulsion intubation, a perforation developed in 11 (10.5%), which was responsible for the death of 4 patients (3.8%). A further 3 patients died of malignant cachexia, which resulted in an overall mortality of 6.7%. Late complications included tube displacement (4 patients; 3.8%) and tube obstruction (32 patients; 30.5%). Tube obstruction was due to advancement of malignant disease in 26 patients (81.2%) and food bolus impaction in the remaining 6 patients (18.8%). Pulsion intubation for advanced carcinoma of the esophagus can be performed with a low morbidity and early mortality. However, there is a substantial long-term morbidity of tube obstruction in almost a third of survivors.

Glucagon, Diarrhea, and Cerebral Symptoms

To the Editor.— Glucagon in pharmacological doses has been widely used to treat insulin reactions, food bolus impaction, and acute pancreatitis and as a hypotonic agent in gastrointestinal (GI) radiology. We report a potentially serious complication after the diagnostic use of this usually innocuous hormone. Report of a Case.— A mentally intact, nondiabetic, mildly hypertensive 78-year-old woman underwent double-contrast upper GI tract x-ray examination for dyspepsia. The examination was completed smoothly using 0.5 mg of glucagon injected intravenously; this agent is given routinely in our institution to enhance mucosal detail in air-barium contrast studies of the stomach. After 30 minutes the patient complained of dizziness and abdominal cramping and abruptly lost consciousness. No seizure movements were observed. When she woke up after two minutes, she was noted to have a paretic right arm, a right central facial paresis, and a blood pressure (BP) of 100/60 mm Hg. Over the next