From the Guidelines
The management of esophageal food impaction should begin with immediate assessment and intervention, with endoscopic removal being the gold standard treatment, ideally performed within 6 hours of impaction, as recommended by the World Journal of Emergency Surgery 1. The goal of treatment is to prevent complications such as perforation, aspiration, or mediastinitis.
- Before endoscopy, gentle pushing of the bolus into the stomach is recommended for the treatment of esophageal food bolus impaction, as it is associated with a low complication rate and up to 90% success rate 1.
- If this procedure is not successful, retrieval should be considered, and the push technique or extraction methods can be used depending on the situation.
- Post-removal, patients should undergo evaluation for underlying esophageal pathology, as most impactions occur due to structural abnormalities like eosinophilic esophagitis, strictures, or rings.
- For patients with identified eosinophilic esophagitis, maintenance therapy with proton pump inhibitors or topical steroids is recommended to prevent recurrence, as shown in studies such as the one published in the Journal of Allergy and Clinical Immunology 1.
- Dietary modifications including avoiding large food boluses and thorough chewing are essential preventive measures for all patients with a history of impaction. Key considerations in the management of esophageal food impaction include:
- The risk of complications such as perforation, aspiration, or mediastinitis, which can be prevented with prompt endoscopic removal.
- The importance of evaluating for underlying esophageal pathology, such as eosinophilic esophagitis, to prevent recurrence.
- The need for dietary modifications to prevent future impactions. In terms of specific treatment options, the study published in the World Journal of Emergency Surgery 1 provides guidance on the use of endoscopic removal and the push technique for the treatment of esophageal food bolus impaction. Additionally, the studies published in the Journal of Allergy and Clinical Immunology 1 provide information on the management of eosinophilic esophagitis, including the use of proton pump inhibitors and topical steroids.
From the Research
Management of Esophageal Impaction Secondary to Food
The management of esophageal impaction secondary to food can be approached through various methods, including medical therapy and endoscopic interventions.
- Medical therapy with glucagon has been traditionally used, with varying success rates, as reported in 2 and 3.
- Endoscopic interventions, such as the push technique and retrieval technique, are commonly used, with the push technique being advised against in the past but now considered safe, as stated in 4.
- The choice of treatment may depend on the severity of the impaction, the presence of underlying esophageal pathology, and the patient's clinical symptoms, as discussed in 5 and 6.
Treatment Options
- Medications, such as glucagon, can be successful in relieving impactions, with a success rate of around 34.5%, as reported in 4.
- Urgent endoscopy is often necessary, with a success rate of around 94.8% for endoscopic therapeutic intervention, as stated in 6.
- The endoscopic push technique and retrieval technique are both effective, with no significant difference in complications, as reported in 4.
Underlying Esophageal Pathology
- Patients presenting with food impaction often have underlying esophageal pathology, such as esophagitis, strictures, hiatal hernias, and Schatzki's rings, as discussed in 6.
- Diabetes mellitus may be associated with food impaction, but more studies are needed to determine the strength of this association, as stated in 6.