TY - JOUR
T1 - The evolution of treatment and complications of esophageal food impaction
AU - Schupack, Daniel A.
AU - Lenz, Charles J.
AU - Geno, Debra M.
AU - Tholen, Crystal J.
AU - Leggett, Cadman L.
AU - Katzka, David A.
AU - Alexander, Jeffrey A.
N1 - Publisher Copyright:
© Author(s) 2019.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - Endoscopic therapy
KW - eosinophilic esophagitis
KW - esophageal complications
KW - esophageal food impaction
KW - noninvasive therapy
UR - http://www.scopus.com/inward/record.url?scp=85062723038&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062723038&partnerID=8YFLogxK
U2 - 10.1177/2050640619836052
DO - 10.1177/2050640619836052
M3 - Article
C2 - 31065372
AN - SCOPUS:85062723038
SN - 2050-6406
VL - 7
SP - 548
EP - 556
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 4
ER -