Post written by Timothy Krill, MD, from the Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA.
The focus of this study was to evaluate rates of adverse events in esophageal soft food impactions relative to time to endoscopy. We compared differences in outcomes between those who underwent an EGD within 12 hours (early) versus beyond 12 hours (delayed) of symptom onset. Soft food was defined as any food that did not contain hard or sharp objects, such as bones.
Food impactions are a common consult that get gastroenterologists out of bed at night. Many probably wonder to themselves if the outcome would be different if the EGD could be postponed until the morning. These impactions frequently consist of either meat or bread and do not possess any hard objects. Most of the existing studies on this topic included foreign bodies of any kind in the upper GI tract, such as sharp objects and bones. These studies found increased rates of adverse events with sharp objects and impaction duration over 12-24 hours. Previous research regarding soft food impactions of the esophagus has been descriptive in nature. Given the lack of data in this frequently encountered cohort of patients, we felt the need to perform this study.
A total of 110 patients with esophageal soft food impactions were identified. Forty-two had an early intervention and 68 a delayed. Endoscopic accessory use for impaction removal was similar for both groups. Success of the push technique alone (defined as forward movement of the endoscope to dislodge the impaction) approached statistical significance for being more common in the early group.
Primary outcomes included local esophageal adverse events (tear, perforation, surgery, ulceration), aspiration, admission, and 30-day mortality. There were no statistically significant differences between both groups for these outcomes. A multivariate analysis was performed to evaluate predictors of local esophageal adverse events. Endoscopic accessory use was found to be associated with significantly increased odds of adverse events. However, delayed intervention was not associated with adverse events.
While we did not find that delayed intervention itself was associated with adverse events, endoscopic accessory use was significantly associated with these outcomes. Success of the push technique alone did approach statistical significance for being more common in the early group. This suggests that early intervention could be associated with a decreased requirement for endoscopic accessories. While we did not find a statistical difference, future studies with higher power are needed to further investigate these findings.
To our knowledge, this is the first study evaluating time to intervention and factors associated with adverse events in esophageal soft food impactions. Understanding outcomes in these patients is vital given it is a frequently encountered scenario by many gastroenterologists.
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