Elsevier

Gastrointestinal Endoscopy

Volume 53, Issue 2, February 2001, Pages 178-181
Gastrointestinal Endoscopy

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

Presented in part during Digestive Disease Week, May 16-19, 1999, Orlando, Florida.
https://doi.org/10.1067/mge.2001.111039Get rights and content

Abstract

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.)

Section snippets

Patients and methods

All patients with a diagnosis of AEFI made from 1993 to 1998 were identified by computer search of our billing database (Physicians Computer Network, Morris Plains, N.J.) for ICD-9 diagnosis code 935.1 (foreign body of the esophagus). Five-year retrospective data are available with this software package. Patients were excluded if they were less than 18 years of age, they had acute esophageal obstruction by a foreign body rather than food impaction, or if their chart was incomplete (missing or

Results

The analysis included 189 patients with a mean age of 60 years (range 18-97). There were 114 men (mean age 55.5 years) and 75 women (mean age 66.4 years). There were 86 patients (46%) over the age of 65 years and 28 patients (15%) over the age of 80 years.

Seventy-seven patients (41%) had a Schatzki's ring, 61 (32%) had an esophageal stricture, and 4 (2%) had esophageal cancer. In addition to these findings, 67 patients had breaks in the esophageal mucosa. In 47 patients (25%), no obvious

Discussion

AEFI is the most common cause of acute esophageal obstruction in adults.2 The push technique has been reported to be safe and effective in the management of patients with AEFI.2, 7, 8, 9, 10 The push technique is advocated in certain clinical situations, such as in patients without a history of dysphagia, in those with a history of dysphagia of short duration, or in those in whom the food bolus has fragmented and extraction is difficult.2, 7, 10 In cases in which there is a solid food bolus, an

Acknowledgements

We thank Arnold M. Rosen, MD, for his helpful comments and suggestions in reviewing this manuscript.

References (14)

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    Thirdly, we identified using the endoscope to push food into the stomach as a potentially risky maneuver for esophageal perforation in EoE [31,60,66,67,70]. Despite a recent retrospective series showing the push technique to be as safe and effective as the pull technique in managing esophageal food bolus impaction in adults [81–84] and children [85], only a minority of patients had EoE. Until we have prospective studies to assess the safety of pushing the food bolus into the stomach in patients with known or suspected EoE, caution should be recommended with this technique.

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Reprint requests: Joseph J. Vicari, MD, Rockford Gastroenterology Associates, 401 Roxbury Road, Rockford, IL 61107.

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