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Endoscopy III
PWE-217 Is “push” an effective and safe method for relief of oesophageal food bolus obstruction on endoscopy?
  1. V Mahesh,
  2. M Schoeman
  1. Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia

Abstract

Introduction Food bolus obstruction of the oesophagus is not an uncommon acute presentation, but data on safe and effective endoscopic management is limited. Although “push” technique with the endoscope is commonly employed, no data on its safety and efficacy compared to other modalities is available.

Aim To evaluate the safety and efficacy of various endoscopic modalities for relief of acute oesophageal food bolus obstruction.

Methods Retrospective study of prospectively collected data. All patients presenting to the department of Gastroenterology at Royal Adelaide hospital, a tertiary centre in South Australia from January 1996 to November 2011 were included in the study. Detailed data on endoscopy, histopathology and complications were collected.

Results In total 288 patients presented with acute oesophageal food bolus obstruction. 70% male patients (202M:86 F); average age of 58.2 yrs±1.7 yrs at presentation. 150 (52%) patients had procedure with anaesthetic assist (± tracheal intubation), 135 (47%) with intravenous sedation (midazolam and fentanyl) and 3 (1%) with only topical anaesthesia. 44 (15%) patients had food bolus in the proximal, 59 (21%) in the mid and 146 (51%) in the distal oesophagus. In 39 (14%) food bolus had spontaneously cleared the oesophagus at endoscopy. The contributing aetiology for food bolus obstruction is described in Abstract PWE-217 table 1. Incomplete data on the type of food was available, but majority were documented to be meat bolus. Push technique was solely and successfully used in 167 (67%) compared to combination of techniques after failed “push” in 53 (21.2%) patients {forceps ± snare ± overtube ± basket} (p<0.01). Remnant 24 (9.6%) patients had one of the following: overtube/hood 5 (2%), forceps 8 (3.2%), snare 2 (1%), basket 5 (2%), suction 1 (0.4%) and wire guided dilatation 3 (1.2%). In five (2%) patients endoscopy was unsuccessful, one removed via rigid oesophagoscopy, four others passed food bolus spontaneously. Additional therapies like bougie and balloon dilatation was done in 64 (24.7%) patients at the index endoscopy. No complication/s attributable to endoscopy/technique was documented.

Abstract PWE-217 Table 1

Conclusion This is the first study to clearly show the safety and efficacy of push technique in relief of oesophageal food bolus obstruction. Combination of manoeuvres is the next best option; tracheal intubation to protect airway must be considered. Limitations of the study include retrospective nature and incomplete data on the type of food bolus.

Competing interests None declared.

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