What is the dose of glucagon (intravenous glucagon) for esophageal food impaction?

Glucagon Dosage for Esophageal Food Impaction

Glucagon is not recommended for the treatment of esophageal food impaction due to lack of evidence for effectiveness and potential adverse effects. 1 Instead, endoscopic management should be pursued as first-line treatment.

Recommended Management Approach

First-Line Treatment

• Therapeutic flexible endoscopy is the recommended first-line treatment for persistent esophageal food impactions 2
• Timing of endoscopy:
  • Emergent flexible endoscopy (within 2-6 hours) for food bolus causing complete esophageal obstruction 2
  • Urgent endoscopy (<24 hours) for food impaction without complete obstruction 2

Endoscopic Techniques

1. Push technique: Gentle instrumental pushing with air insufflation (success rate up to 90%) 2
2. Retrieval techniques: If push technique fails, use baskets, snares, or grasping forceps 2
3. Balloon catheter method: For large food bolus jammed in lower esophagus, pass a balloon catheter past the bolus, inflate, and withdraw to disimpact 2

Why Glucagon Is Not Recommended

Despite historical use, current evidence does not support glucagon for esophageal food impaction:

• A systematic review found no evidence for glucagon's effectiveness in this situation 1
• Potential adverse effects include vomiting, which increases the risk of esophageal perforation 1
• Studies examining glucagon's effect on esophageal motor function found:
  • Maximum reduction in lower esophageal sphincter (LES) pressure was achieved with 0.5 mg, with no additional benefit from higher doses 3
  • Nausea is a common side effect, especially with 1 mg doses 3
  • No significant advantage of 0.5 mg over 0.25 mg for therapeutic effect 3

Important Clinical Considerations

Diagnostic Approach

• CT scan is essential if perforation is suspected 2
• Avoid contrast swallow studies as they may:
  • Increase aspiration risk in patients with complete obstruction
  • Coat the foreign body and impair endoscopic visualization 2

Post-Impaction Evaluation

• Diagnostic work-up for underlying esophageal disorders is recommended, as up to 25% of patients have conditions such as:
  • Esophageal stricture
  • Hiatus hernia
  • Schatzki ring
  • Eosinophilic esophagitis (found in up to 9% of patients)
  • Achalasia
  • Tumors 2

Risk Factors for Failed Conservative Management

• Presence of fixed esophageal obstruction
• Meat bolus (more likely to require intervention than other food types) 4
• Longer duration of symptoms before presentation 4

By prioritizing prompt endoscopic management rather than glucagon administration, clinicians can provide more effective care while reducing the risk of complications for patients with esophageal food impaction.