What is the treatment for a dislodged item in the esophagus?

From the Guidelines

The treatment for a dislodged item in the esophagus typically requires immediate medical intervention, with endoscopy being the primary treatment method, as indicated by the most recent guidelines 1. The approach depends on the type of object and its location, with non-food objects or sharp items necessitating immediate attention due to the risk of perforation or other complications.

• Key considerations include:
  • The nature of the object: batteries and sharp items require immediate removal due to the risk of chemical burns or perforation.
  • The location of the object: endoscopy is used to locate and remove the object.
  • The symptoms presented: smooth, small objects that aren't causing significant symptoms may be managed with a "watch and wait" approach. In some cases, glucagon (1 mg intravenously) may be administered to relax the esophageal muscles and allow the object to pass naturally, particularly for food impactions 1.
• The decision to perform oesophageal dilatation, if necessary, should be made by a team approach, including endoscopists and radiologists, as outlined in the guidelines 1. Surgical intervention is rarely needed but may be necessary for objects that cannot be removed endoscopically or have caused complications.
• It is essential to prioritize the patient's safety and well-being, considering the potential risks and benefits of each treatment approach, as emphasized in the guidelines 1. The urgency of treatment depends on the nature of the object, with batteries and sharp items requiring immediate removal, while food impactions may be treated with meat tenderizers or carbonated beverages in some cases before attempting more invasive procedures.
• Ultimately, the goal of treatment is to alleviate symptoms, permit maintenance of oral nutrition, and reduce the risk of pulmonary aspiration, as stated in the guidelines 1.

From the Research

Treatment Options for Dislodged Item in Esophagus

• The treatment for a dislodged item in the esophagus can vary depending on the type of item, the duration of the ingestion, and the patient's overall health.
• According to a study published in 2008 2, bougienage or endoscopy can be used to manage coins acutely lodged in the esophagus, with bougienage offering a safe and effective alternative to other methods of coin management in properly screened patients.
• Another study published in 1977 3 suggests that intravenous glucagon can be used to relieve esophageal food impaction, providing a safe and effective acute-care radiologic adjunct.
• A review published in 2019 4 recommends that patients with esophageal foreign bodies or food bolus impaction should be assessed and managed based on evidence-based recommendations, with endoscopy being the intervention of choice for complete obstruction.
• The choice of method for removing an ingested coin lodged in the esophagus can depend on the duration of the ingestion and the risk for compromise to the esophageal mucosal integrity, as discussed in a study published in 1994 5.
• Esophageal disorders, including dysphagia and odynophagia, should be taken seriously and addressed promptly, as discussed in an article published in 1996 6.

Considerations for Treatment

• The patient's airway should be assessed initially, and medications such as effervescent agents, glucagon, calcium channel blockers, benzodiazepines, and nitrates may be considered, but their efficacy is poor 4.
• Endoscopy is the preferred method for removing esophageal foreign bodies or food bolus impactions, and medications should not delay endoscopy 4.
• Early endoscopy for complete obstruction is associated with improved outcomes 4.
• The duration of the ingestion and the risk for compromise to the esophageal mucosal integrity should be considered when choosing a method for removing an ingested coin lodged in the esophagus 5.