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de Benito Sanz M, Tejedor-Tejada J, Mangas-Sanjuan C, Santa EDL, Cebrian I, Talegón R, Sánchez-Ocaña R, Pérez-Pariente JM, Pérez-Miranda M, García-Alonso FJ. Double-Blind Multicenter Randomized Clinical Trial Comparing Glucagon vs Placebo in the Resolution of Alimentary Esophageal Impaction. Am J Gastroenterol 2024; 119:87-96. [PMID: 37734342 DOI: 10.14309/ajg.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of glucagon vs placebo in resolving esophageal foreign body impaction (EFBI), as well as the length of the procedure and adverse events. METHODS This was a multicenter, randomized, double-blind trial involving consecutive patients diagnosed with alimentary EFBI. Participants were randomized to receive either 1 mg of intravenous glucagon or placebo. All patients underwent upper endoscopy, and adverse events were assessed through a protocolized telephonic interview 7 days later. RESULTS The study included 72 subjects in the glucagon group and 68 in the placebo group. The foreign body was not identified in 23.6% of subjects in the glucagon group and 20.6% of subjects in the placebo group (difference 3%, 95% confidence interval -10.7% to 16.8%, P = 0.67). The median time required to remove the foreign body was similar in both groups 4 minutes (range 2-10) in the glucagon group and 3.5 minutes (range 2-7) in the placebo group (difference 0.5 minutes, 95% confidence interval -1.3 to 2.3; P = 0.59). The most common adverse event reported in both groups was mild pharyngeal pain. DISCUSSION Glucagon is no more effective than placebo in resolving EFBI or shortening the time required to remove the foreign body (EUDRA-CT number 2019-004920-40).
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Affiliation(s)
- Marina de Benito Sanz
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Eva de la Santa
- Department of Gastroenterology, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Irene Cebrian
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Raquel Talegón
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ramón Sánchez-Ocaña
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - Manuel Pérez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Tiebie EG, Baerends EP, Boeije T, Frankenmolen PG, Lameijer H, van den Berg W, van Stralen KJ, Ridderikhof ML, Bredenoord AJ. Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial. BMJ 2023; 383:e077294. [PMID: 38081653 PMCID: PMC10711662 DOI: 10.1136/bmj-2023-077294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of cola in resolving complete oesophageal food bolus impaction. DESIGN Open label, multicentre, randomised controlled trial. SETTING Emergency departments of five Dutch hospitals at the secondary and tertiary level, between 22 December 2019 and 16 June 2022. PARTICIPANTS 51 adults presenting with complete oesophageal food bolus impaction, defined as a sudden inability to pass saliva after consumption of foods. Patients who ingested meat that contained bones, and patients with an American Society of Anesthesiologists (ASA) physical status classification of IV or higher were excluded. INTERVENTIONS 28 patients in the intervention group were instructed to consume 25 mL cups of cola at intervals up to a maximum total volume of 200 mL. 23 patients in the control group awaited spontaneous passage. In either group, if complete resolution of symptoms did not occur, endoscopic removal was performed following current guidelines: within 6 hours for patients with complete obstruction, and within 24 hours for partial obstruction. In case of complete resolution of symptoms, elective diagnostic endoscopy was required. MAIN OUTCOME MEASURES Improvement of oesophageal food bolus obstruction as reported by patients (ie, aggregate of complete and partial passage), and evaluation of complete passage. The secondary outcome was any intervention related adverse event. RESULTS Cola did not have a meaningful effect on the improvement of food bolus obstruction (17/28 (61%) intervention v 14/23 (61%) control; odds ratio 1.00, 95% confidence interval 0.33 to 3.1; relative risk reduction 0.0, 95% confidence interval -0.55 to 0.36; P>0.99). Complete passage was reported more often in the intervention group but this difference was not significant (12/28 (43%) intervention v 8/23 (35%) control; odds ratio 1.4 (0.45 to 4.4); relative risk reduction -0.23 (-1.5 to 0.39); P=0.58). No severe adverse events occurred. However, six (21%) patients in the intervention group experienced temporary discomfort after drinking cola. CONCLUSIONS In this study, cola consumption did not lead to a higher rate of improvement of complete oesophageal food bolus impaction. Given the lack of adverse events in the treatment group and some events of resolution after treatment, cola might be considered as a first line treatment, but should not delay any planning of endoscopic management. TRIAL REGISTRATION Netherlands Trial Register (currently International Clinical Trial Registry Platform) NL8312.
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Affiliation(s)
- E G Tiebie
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - E P Baerends
- Department of Emergency Medicine, Victoria Hospital, Wynberg, Cape Town, South Africa
| | - T Boeije
- Department of Emergency Medicine, Dijklander Hospital, Hoorn, Netherlands
| | - P G Frankenmolen
- Department of Emergency Medicine, OLVG hospital, Amsterdam, Netherlands
| | - H Lameijer
- Department of Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - W van den Berg
- Department of Emergency Medicine, Rode Kruis hospital, Beverwijk, Netherlands
| | - K J van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Haarlem, Netherlands
| | - M L Ridderikhof
- Department of Emergency Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - A J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
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Guo H, Hamilton P, Enns E, Gupta M, Andrews CN, Nasser Y, Bredenoord AJ, Dellon ES, Ma C. Postendoscopy Care for Patients Presenting With Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study. Am J Gastroenterol 2023; 118:1787-1796. [PMID: 37410911 DOI: 10.14309/ajg.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Esophageal food bolus impactions (FBI) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction but also medical follow-up and treatment for the underlying esophageal pathology. We evaluated the appropriateness of postendoscopy care for patients with FBI and assessed patient-related, physician-related, and system-related factors that may contribute to loss to follow-up. METHODS We conducted a retrospective, population-based, multicenter cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada, from 2016 to 2018. Appropriate postendoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton-pump inhibitors or endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression. RESULTS A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate postendoscopy care. Half of the patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and among this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including 3 new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio 7.28, 95% confidence interval 4.49-11.78, P < 0.001) more likely to receive inappropriate postendoscopy follow-up and treatment, even after adjusting for age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions. DISCUSSION One-quarter of patients presenting with an FBI do not receive appropriate postendoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.
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Affiliation(s)
- Howard Guo
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamilton
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edwin Enns
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Milli Gupta
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Ma
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gangwani MK, Aziz M, Dahiya DS, Aziz A, Priyanka F, Karna R, Lee-Smith W, Ahmed Z, Kamal F, Inamdar S, Alastal Y, Adler D. Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis. Dig Dis Sci 2023:10.1007/s10620-023-07988-0. [PMID: 37278950 DOI: 10.1007/s10620-023-07988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Esophageal food impaction (EFI) is a common GI emergency. Push and pull methods are used currently for EFI retrieval. We aim to review current available literature to compare success rates and evaluate adverse event rates of the two techniques. METHODS A comprehensive literature search was performed using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, SciELO and Global Index Medicus. Odds ratio (OR) with 95% confidence interval (CI) was calculated when comparing the dichotomous variables. We aimed to evaluate technical success and adverse events for EFI comparing push and pull technique on single arm and comparator analysis. RESULTS The search strategy yielded a total of 126 articles. 18 studies with 3528 participants were included. The technical success rate was 97.5% (CI 96.6-99.2%) in the push and 88.4% (CI 72.8-98.7%) in the pull technique with no statistical difference on comparator analysis. Overall rate of adverse events was 4.03% (CI 0.9-5.0%) in the push technique and 2.22% (CI 0-2.9%) in the pull technique with no statistical difference on comparator analysis (OR 95% CI 0.464-2.782, p = 0.78, I2 = 31.54%). There was no statistical difference between rate of lacerations and perforations either between the two techniques. CONCLUSION Both techniques have acceptable clinical outcomes which appear within standard of care. Operator experience and individual clinical scenarios should guide decision-making regarding technique selection.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Dushyant Singh Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, 48603, USA
| | - Abeer Aziz
- Department of Gastroenterology and Hepatology, Augusta University, Augusta, GA, USA
| | - Fnu Priyanka
- Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Rahul Karna
- Department of Medicine, Alleghany General Hospital, Pittsburgh, PA, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Faisal Kamal
- Digestive Health Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yaseen Alastal
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Douglas Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Center Health, Denver, CO, 80210, USA.
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Hoversten P, Lomeli L, Broman AT, Gaumnitz E, Hillman L. Esophageal disease and loss to follow-up are common among patients who experience non-endoscopic resolution of food impaction. Dis Esophagus 2023; 36:6658242. [PMID: 35938855 DOI: 10.1093/dote/doac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Indexed: 12/11/2022]
Abstract
Many patients who experience esophageal food impaction (EFI) will have non-endoscopic resolution (NER) of their EFI, but this population is poorly defined. The purpose of this study is to describe the outcomes of patients with NER of EFI. A retrospective chart review from 2007 to 2017 was performed at a single tertiary care center. There were 593 patients who presented to the emergency department with EFI, defined as recent soft food ingestion and inability to tolerate oral secretions. Adequate follow-up was defined as a gastroenterology clinic visit or EGD within 6 months of EFI. Out of these, 149 patients (25.1%) had NER of their EFI. Patients with NER were less likely to have adequate follow-up than those with ER (45.0% vs. 59.5%, P = 0.003). Of those without established esophageal disease and NER, 92.5% had significant esophageal pathology on endoscopy, including stricture (34.0%), features of eosinophilic esophagitis (30.2%), and esophagitis (22.6%). Recurrent EFI occurred at a similar rate between patients with NER and ER (9.4% vs. 14.6%, P = 0.14). Patients with established esophageal disease (odds ratio [OR]: 1.51, P = 0.04) and recommendation to follow-up at time of EFI (OR: 6.06, P < 0.001) were most likely to follow up after EFI. Approximately, a quarter of patients with EFI will experience NER of their EFI. Virtually, all patients (92.5%) were found to have esophageal disease warranting longitudinal care. Importantly, follow-up rates are significantly lower in those with NER than their counterparts requiring EGD. Our study highlights the need to develop standardized protocols that improve follow-up for patients after NER of EFI.
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Affiliation(s)
- Patrick Hoversten
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Luis Lomeli
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Eric Gaumnitz
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Luke Hillman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Long B, Gottlieb M. Is Glucagon Effective for Relieving Acute Esophageal Foreign Bodies and Food Impactions? Ann Emerg Med 2020; 75:299-301. [DOI: 10.1016/j.annemergmed.2019.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 10/26/2022]
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Aiolfi A, Ferrari D, Riva CG, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scand J Gastroenterol 2019; 53:1171-1178. [PMID: 30394140 DOI: 10.1080/00365521.2018.1526317] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Esophageal Foreign Body (FB) impaction represents a major challenge for healthcare providers. Aim of this systematic review was to analyse the current literature evidence on prevalence, presentation, treatment, and outcomes of impacted esophageal FB. MATERIALS AND METHODS Literature search was conducted between 2000 and 30th June 2018 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. RESULTS Sixty-one studies matched the inclusion criteria. The total number of included patients was 13,092. The cervical esophagus was the most frequent impaction site (67%) and sharp-pointed objects were the most common FB (38.1%). Retrosternal pain (78%), dysphagia (48%), and odynophagia (43.4%) were the most common symptoms. A flexible or rigid endoscopic approach was adopted in 65.1% and 16.8% of patients, respectively. Overall, 17.8% of patients had a complication related to the impacted esophageal FB or to the endoscopic manoeuvers. A surgical approach was required in 3.4% of patients. The overall mortality was 0.85%. CONCLUSIONS Surgery is the upfront treatment in patients with esophageal perforation or endoscopically irretrievable esophageal FB. A minimally invasive approach can be adopted in selected patients. Effective prevention of FB impaction should focus on accurate diagnostic work-up to search for an underlying motility disorder after a first episode of esophageal impaction, even if transient and self-resolving.
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Affiliation(s)
- Alberto Aiolfi
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Davide Ferrari
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Carlo Galdino Riva
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Francesco Toti
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Gianluca Bonitta
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
| | - Luigi Bonavina
- a Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San Donato , University of Milan , Milan , Italy
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David J, Backstedt D, O'Keefe KJ, Salehpour K, Gerkin RD, Ramirez FC. Effervescent agents in acute esophageal food impaction. Dis Esophagus 2019; 32:5250775. [PMID: 30561588 DOI: 10.1093/dote/doy117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/16/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022]
Abstract
Acute esophageal food impaction (AEFI) occurs frequently. Few data are published describing the use of effervescent agents (EAs) for treatment of AEFI. We aimed to evaluate the effectiveness, cost, and safety of EAs in the treatment of AEFI. We retrospectively identified patients aged 18 years and older who were seen in the emergency department of 2 hospitals in 1 metropolitan area from January 1, 2011, through April 4, 2016, who had a clinical diagnosis of AEFI. We collected and analyzed data on outcomes and cost associated with the use of EAs, glucagon, and no pharmacologic therapy. During the study period, 239 patients with AEFI met the inclusion criteria. Of the 45 patients who received EA monotherapy, 25 (55.6%) responded successfully, compared with 11 of 62 (17.7%) who received glucagon monotherapy (P < .001) and 16 of 93 (17.2%) who had no therapy (P < .001). Ten of 39 patients (25.6%) who were given both glucagon and EA responded successfully. The other 177 patients had endoscopy, which was successful in all cases. Median hospitalization charges for patients who responded successfully to EA alone were $1,136, compared with $2,602 for responders to glucagon alone (P < .001) and $1,194 for those who cleared their bolus spontaneously (P < .001). All patients who received EA monotherapy had lower median hospitalization costs ($2,384) than all patients who received glucagon monotherapy ($9,289; P = .03) and all patients who received neither ($8,386; P = .02). Effervescent agents are a safe, effective, and cost-saving initial strategy in the treatment of acute esophageal food impaction.
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Affiliation(s)
- J David
- Section of Gastroenterology, Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix
| | - D Backstedt
- Section of Gastroenterology, Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix
| | - K J O'Keefe
- Section of Gastroenterology, Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix
| | - K Salehpour
- Department of Internal Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix
| | - R D Gerkin
- Department of Internal Medicine, Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix
| | - F C Ramirez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
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Peksa GD, DeMott JM, Slocum GW, Burkins J, Gottlieb M. Glucagon for Relief of Acute Esophageal Foreign Bodies and Food Impactions: A Systematic Review and Meta-Analysis. Pharmacotherapy 2019; 39:463-472. [PMID: 30779190 DOI: 10.1002/phar.2236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Glucagon is frequently used for the relief of esophageal impactions. This systematic review and meta-analysis were performed to evaluate the efficacy and safety of glucagon for acute esophageal foreign body and food impactions. PubMed, CINAHL, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched from inception to March 1, 2018. Retrospective, observational, and randomized controlled trials assessing glucagon for the relief of acute esophageal foreign body and food impaction were included. There were no language or age restrictions. Only studies conducted on humans and with a comparator (e.g., control or placebo) were included. Study quality analysis was performed using the Cochrane Risk of Bias tool. Quality of evidence analysis was performed using the Grading of Recommendations, Assessment, Development and Evaluations approach. A total of 1988 studies were identified, and five studies with a total of 1185 subjects were included. Treatment success occurred in 213 of 706 (30.2%) patients in the glucagon group and 158 of 479 (33.0%) patients in the control group (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.69-1.17, p=0.42). There was minimal statistical heterogeneity (I2 = 14%, p=0.33). No publication bias was identified. Adverse events were identified in 24 (15.0%) patients in the glucagon group and 0 (0%) patients in the placebo group (risk difference [RD] 0.18, 95% CI 0.03-0.33, p=0.02). Vomiting events occurred more frequently in the glucagon group (17 of 160 [10.6%] vs 0 of 53 [0%]) but was not statistically significant (RD 0.07, 95% CI -0.03-0.17, p=0.19). Glucagon was not associated with a difference in treatment success but had a higher rate of adverse events for the treatment of esophageal foreign body and food impaction. Further controlled studies are needed to confirm the efficacy of glucagon with adequate power to assess adverse events.
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Affiliation(s)
- Gary D Peksa
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois.,Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Joshua M DeMott
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois
| | - Giles W Slocum
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois
| | - Jaxson Burkins
- Department of Pharmacy, Mount Sinai Hospital, Chicago, Illinois
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Schupack DA, Lenz CJ, Geno DM, Tholen CJ, Leggett CL, Katzka DA, Alexander JA. The evolution of treatment and complications of esophageal food impaction. United European Gastroenterol J 2019; 7:548-556. [PMID: 31065372 DOI: 10.1177/2050640619836052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background Esophageal food impaction is relatively common and increasing over time. Treatment ranges from medications to invasive endoscopic therapies. The endoscopic push technique has been advised against in favor of endoscopic retrieval for safety concerns. We sought to assess use patterns and safety of treatments for food impaction in a population-based retrospective review. Methods A database of recorded esophageal food impactions in Olmsted County, MN, USA, from 1975-2011 was reviewed for patient demographics, treatment, and complications. Results A total of 645 impactions occurred, with increasing incidence over time, peaking at 23.2 per year (2000-2004). Medications (almost exclusively glucagon) were successful in relieving impactions 34.5% of the time when trialed. Urgent endoscopy was common (74.0%), as was the need for endoscopic therapy (67.1%). Endoscopic therapy increased over time, with the endoscopic push technique becoming most common. Esophageal complications (deep mucosal injury or perforation) increased over time but remained rare (peak 11%). There was no difference in complications between push and retrieval techniques. Conclusions The endoscopic push technique is safe in comparison to endoscopic retrieval in esophageal food impactions. While complications surrounding impaction have increased, they remain rare. Medication trials are reasonable, as long as they do not delay endoscopy, and may prevent the need for emergent endoscopy in one-third of cases.
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Affiliation(s)
- Daniel A Schupack
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Charles J Lenz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Debra M Geno
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Crystal J Tholen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Cadman L Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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11
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Cola therapy for oesophageal food bolus impactions a case series. Afr J Emerg Med 2019; 9:41-44. [PMID: 30873351 PMCID: PMC6399995 DOI: 10.1016/j.afjem.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/09/2018] [Accepted: 09/21/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction This retrospective case series describes the use of cola to immediately treat complete oesophageal food bolus obstructions in the emergency centre. Short of emergent endoscopy – which is invasive, expensive, not without adverse events, and often unavailable in low-resource settings – no other proven therapies exist to relieve oesophageal food impactions. Methods We performed a chart review of adults with complete oesophageal food bolus obstructions presenting to two Dutch emergency centres. Our primary outcome was cola’s success rate in resolving the obstruction. Our secondary outcome was adverse event occurrence. Results We identified 22 cola interventions in 19 patients, the majority of whom (77.3%) were male. The median age was 59 years (IQR 29–73). All presentations were due to meat impaction. Endoscopy revealed relevant upper gastrointestinal pathology in 54.5%. When initiated in the emergency centre, cola successfully resolved 59% of complete oesophageal obstructions. No adverse events were reported in patients successfully treated with cola. Discussion While keenly aware of our retrospective study’s limitations, we found a promising success rate for cola as an acute intervention for oesophageal food bolus impactions. We registered no adverse events attributable to cola. Also, given that cola is cheap, widely available and seemingly safe we believe it can be considered in patients with oesophageal obstructions due to food, either as pre-endoscopy treatment or in case endoscopy is not available at all. We think our findings provide an impetus for prospective research on this intervention.
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Fulforth JM, Chen AJ, Falvey JD. Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction. Emerg Med Australas 2019; 31:745-749. [PMID: 30719844 DOI: 10.1111/1742-6723.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. METHODS A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. RESULTS A total of 116 patients presented with symptoms of FBO. Twenty-seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy-one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). CONCLUSIONS Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.
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Affiliation(s)
- James M Fulforth
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
| | - Amanda J Chen
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
| | - James D Falvey
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
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Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, Toti F, Bonavina L. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis. World J Emerg Surg 2018; 13:42. [PMID: 30214470 PMCID: PMC6134522 DOI: 10.1186/s13017-018-0203-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023] Open
Abstract
Background Foreign body (FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy (FE) is recommended as the first-line therapeutic option because it can be performed under sedation, is cost-effective, and is well tolerated. Rigid endoscopy (RE) under general anesthesia is less used but may be advantageous in some circumstances. The aim of the study was to compare the efficacy and safety of FE and RE in esophageal FB removal. Methods PubMed, MEDLINE, Embase, and Cochrane databases were consulted matching the terms "Rigid endoscopy AND Flexible endoscopy AND foreign bod*". Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2 index and Cochrane Q test. Results Five observational cohort studies, published between 1993 and 2015, matched the inclusion criteria. One thousand four hundred and two patients were included; FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48-2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96-8.61; p = 0.06), 1.09 (95% CI 0.38-3.18; p = 0.87), and 1.50 (95% CI 0.53-4.25; p = 0.44), respectively. There was no mortality. Conclusions FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. Formal training and certification in RE should probably be re-evaluated.
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Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Galdino Riva
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Rausa
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Toti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan, 1, 20097 San Donato Milanese, Milan, Italy
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Carr MJ, Oxner C, Elster EA, Ritter EM, Vicente D. Management of Acute Upper Gastrointestinal Disease While at Sea. Mil Med 2018; 183:e658-e662. [PMID: 29420777 DOI: 10.1093/milmed/usx103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/21/2017] [Indexed: 11/14/2022] Open
Abstract
Management of complex acute surgical pathology in austere environments necessitates rapid evaluation and resource appropriate management to avoid time-associated morbidity and potentially mortality. Obstructive upper gastrointestinal (UGI) pathologies can be particularly challenging and associated with significant morbidity. Herein, we present six patients with UGI obstructions encountered over the course of an 8-mo deployment onboard a US Navy Aircraft Carrier. Each patient presented to our medical department with signs and symptoms of obstructive UGI pathology including one gastric volvulus requiring operative management at sea, one with a new diagnosis of achalasia requiring transportation and continental United States outpatient evaluation, and four patients with food impaction requiring urgent endoscopic management. Although UGI pathology is seldom encountered at sea, definitive surgical interventions, including prompt evaluation and management of these acute pathologies, can be performed in an austere environment. We wish to call attention to these potential encounters in order that underway deployed medical units and supporting resources ashore are prepared and equipped to intervene on acute UGI obstructive pathology.
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Affiliation(s)
- Matthew J Carr
- Aviation Medicine, Carrier Airwing Seven, 1640 Tomcat blvd STE 300, Virginia Beach, VA
| | - Christopher Oxner
- Department of General Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA
| | - Eric A Elster
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
| | - Eric M Ritter
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
| | - Diego Vicente
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
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