A Protocol to Manage Esophageal Food Impaction

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Esophageal food impaction is usually managed by emergent endoscopy to dislodge the food bolus from the esophagus. We present our experience with a multi step protocol to promote spontaneous passage of the food bolus. Methods: Patients presenting with esophageal food bolus were treated with the following protocol; 1) Vigorous hydration with IV fluid D5NS 10 meq KCL/L and 1 gram Magnesium sulfate/L at 300-350 mls/ hour. 2) having patient stand up straight and extend arms over head for 15-12 seconds periodically once at least 750-1000 mls of fluid has been infused. 3) glucagon 1 mgs IV 4) oral nitroglycerin 0.4 mgs tablet crushed into 6-8 mls of water, after at least 750-1000 mls of fluid infused and glucagon given. 5) repeat standing up straight with arms extended overhead. Twelve patients; age 19 to 83, 10 men and 2 women, were treated with this protocol. Results: The above protocol was administered to 12 patients with esophageal food impaction. 4 patients passed the food bolus spontaneously and went home within 5-7 hours of presentation to ER after demonstrating that they could drink water. 5 other patients experienced relief of the esophageal obstruction symptoms but underwent endoscopy and no food was found in the esophagus and 3 of these patients were NOT intubated for the endoscopy. The 3 remaining patients were able to swallow their saliva and able to comfortably wait until the am for the endoscopy and food was found in the esophagus of these patients. Esophageal biopsies showed Eosinophilic Esophagitis (EoE) in 6 patients, all under age 65. Esophageal biopsies were negative for EoE in 5 patients, all over age 59. 1 patient who was able to go home without EGD has not yet had EGD. Conclusion: A protocol of vigorous hydration, IV magnesium, upright posture, IV glucagon and oral nitroglycerin may be useful in patients with esophageal food impaction and deserves further study

Volume

119

Issue

10S

First Page

S485

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

DOI

10.14309/01.ajg.0001032180.74665.2a

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