What is the treatment for a meat bolus (esophageal obstruction)?

Management of Esophageal Meat Bolus Impaction

Flexible endoscopy is the recommended first-line treatment for esophageal meat bolus impaction, with a success rate of up to 90%, and should be performed with adequate anesthetic support for airway management. 1

Initial Assessment and Management

• Avoid conservative treatments such as fizzy drinks, baclofen, salbutamol, or benzodiazepines as there is no evidence supporting their efficacy 1
• Despite some research suggesting fruit juices (particularly pineapple and kiwi) may help dislodge meat boluses in vitro 2, clinical guidelines do not support this approach

Endoscopic Management

Preferred Techniques:

1. Flexible endoscopy with either:

   • "Push technique" - advancing the bolus into the stomach
   • "Extraction technique" - removing the bolus through the mouth 1

2. Device selection:

   • Roth nets have been reported as particularly effective for food bolus retrieval 3
   • Other useful tools include Dormia baskets, retrieval forceps, and polypectomy snares 3

Procedural Considerations:

• Ensure adequate anesthetic support for airway management 1
• Consider combined flexible and rigid endoscopy for better visualization and retrieval 1
• Fluoroscopic guidance may enhance safety in high-risk cases 1

Post-Procedure Care and Diagnosis

• Obtain at least 6 esophageal biopsies from different anatomical sites during the index endoscopy 1

  • Eosinophilic esophagitis (EoE) is found in up to 46% of cases and is the most common benign cause 1

• Monitor patient for at least 2 hours in recovery 1

  • Watch for signs of perforation: pain, breathlessness, fever, or tachycardia

• Provide clear written instructions on:

  • Fluid and diet recommendations
  • Medication guidance
  • Contact information for the on-call team 1

Underlying Causes and Follow-Up

• Underlying esophageal disorders are found in up to 25% of patients with food bolus impaction 1:

  • Eosinophilic esophagitis
  • Esophageal strictures (found in 69% of cases) 4
  • Schatzki rings (found in 19% of cases) 4
  • Hiatus hernia
  • Achalasia
  • Tumors

• If a stricture is identified, immediate dilatation may be performed during the same procedure 1, 4

• For confirmed EoE:

  • Initiate topical corticosteroid therapy
  • Consider dietary therapy
  • Schedule repeat endoscopy in 6-8 weeks to assess treatment response 1

Important Caveats

• Withhold proton pump inhibitors for at least 3 weeks prior to follow-up endoscopy if EoE is suspected but not confirmed 1

• CT scan with oral contrast is recommended if:

  • Persistent chest pain develops
  • Perforation or other complications are suspected 1

• Plain radiographs have limited utility with high false-negative rates (up to 85%) for food bolus impaction 1

• Failure to obtain biopsies during the initial procedure results in significant loss to follow-up and failure to diagnose underlying causes 1

• Surgical intervention is rarely needed (only 1.4% of cases) but should be considered for foreign bodies embedded in tissue 1, 3