Outcomes of delayed endoscopic management for esophageal soft food impactions

Published:December 21, 2019DOI:

      Background and Aims

      Food impactions are a common reason for emergent upper endoscopy. Current guidelines call for urgent upper endoscopy (within 24 hours) for food impactions without complete esophageal obstruction and emergent endoscopy (within 6 hours) for those with complete esophageal obstruction. Multiple adverse events can arise from esophageal foreign bodies. Cases with longer delays from symptom onset to presentation have been associated with higher rates of surgical intervention. However, data on esophageal soft food impactions are scant. We set out to determine differences in outcomes for food impactions undergoing intervention within 12 hours versus over 12 hours of symptom onset.


      A retrospective review of medical records was conducted to identify patients who presented to our hospital with an esophageal soft food impaction and underwent an EGD between January 2010 and January 2018. Patients were divided into 2 groups based on the timing from symptom onset to EGD. An EGD within 12 hours was considered an early intervention and over 12 hours was considered a delayed intervention. Patients who had ingested bones or hard objects were not included. Primary outcomes studied were rates of aspiration, admission, local esophageal adverse events, and 30-day all-cause mortality.


      We identified 110 patients with a soft food impaction who underwent an EGD. Forty- two patients had an early intervention and 68 a delayed intervention. There were no differences in basic demographics and comorbidities. Additionally, there were no differences in rates of local esophageal adverse events, aspiration, admission, or 30-day mortality. Multivariate analysis revealed endoscopic accessory use was associated with increased odds of local esophageal adverse events (odds ratio, 6.37; P = .01).


      The overall rates of serious adverse events in esophageal soft food impactions are low. Delayed intervention is not associated with increased adverse events or 30-day mortality compared with early intervention. However, accessory use is associated with higher adverse event rates.


      EoE (eosinophilic esophagitis)
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        • Ikenberry S.O.
        • Jue T.L.
        • Anderson M.A.
        • et al.
        Management of ingested foreign bodies and food impactions.
        Gastrointest Endosc. 2011; 73: 1085-1091
        • Birk M.
        • Bauerfeind P.
        • Deprez P.H.
        • et al.
        Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.
        Endoscopy. 2016; 48: 489-496
        • Vizcarrondo F.J.
        • Brady P.G.
        • Nord H.J.
        Foreign bodies of the upper gastrointestinal tract.
        Gastrointest Endosc. 1983; 29: 208-210
        • Mosca S.
        • Manes G.
        • Martino R.
        • et al.
        Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients.
        Endoscopy. 2001; 33: 692-696
        • Wu W.T.
        • Chiu C.T.
        • Kuo C.J.
        • et al.
        Endoscopic management of suspected esophageal foreign body in adults.
        Dis Esophagus. 2011; 24: 131-137
        • Longstreth G.F.
        • Longstreth K.J.
        • Yao J.F.
        Esophageal food impaction: epidemiology and therapy. A retrospective, observational study.
        Gastrointest Endosc. 2001; 53: 193-198
        • Webb W.A.
        • McDaniel L.
        • Jones L.
        Foreign bodies of the upper gastrointestinal tract: current management.
        South Med J. 1984; 77: 1083-1086
        • Webb W.A.
        Management of foreign bodies of the upper gastrointestinal tract.
        Gastroenterology. 1988; 94: 204-216
        • Henderson C.T.
        • Engel J.
        • Schlesinger P.
        Foreign body ingestion: review and suggested guidelines for management.
        Endoscopy. 1987; 19: 68-71
        • Nandi P.
        • Ong G.B.
        Foreign body in the oesophagus: review of 2394 cases.
        Br J Surg. 1978; 65: 5-9
        • Chaikhouni A.
        • Kratz J.M.
        • Crawford F.A.
        Foreign bodies of the esophagus.
        Am Surg. 1985; 51: 173-179
        • Webb W.A.
        Management of foreign bodies of the upper gastrointestinal tract: update.
        Gastrointest Endosc. 1995; 41: 39-51
        • Katsinelos P.
        • Kountouras J.
        • Paroutoglou G.
        • et al.
        Endoscopic techniques and management of foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: a retrospective analysis of 139 cases.
        J Clin Gastroenterol. 2006; 40: 784-789
        • Lacy P.D.
        • Donnelly M.J.
        • McGrath J.P.
        • et al.
        Acute food bolus impaction: aetiology and management.
        J Laryngol Otol. 1997; 111: 1158-1161
        • Vicari J.J.
        • Johanson J.F.
        • Frakes J.T.
        Outcomes of acute esophageal food impaction: success of the push technique.
        Gastrointest Endosc. 2001; 53: 178-181
        • Kerlin P.
        • Jones D.
        • Remedios M.
        • et al.
        Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus.
        J Clin Gastroenterol. 2007; 41: 356-361
        • Weinstock L.B.
        • Shatz B.A.
        • Thyssen S.E.
        Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases.
        Endoscopy. 1999; 31: 421-425
        • Sperry S.L.
        • Crockett S.D.
        • Miller C.B.
        • et al.
        Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis.
        Gastrointest Endosc. 2011; 74: 985-991
        • Cheng W.
        • Tam P.K.
        Foreign-body ingestion in children: experience with 1,265 cases.
        J Pediatr Surg. 1999; 34: 1472-1476
        • Chen M.K.
        • Beierle E.A.
        Gastrointestinal foreign bodies.
        Pediatr Ann. 2001; 30: 736-742
        • Hong K.H.
        • Kim Y.J.
        • Kim J.H.
        • et al.
        Risk factors for complications associated with upper gastrointestinal foreign bodies.
        World J Gastroenterol. 2015; 21: 8125-8131
        • Loh K.S.
        • Tan L.K.
        • Smith J.D.
        • et al.
        Complications of foreign bodies in the esophagus.
        Otolaryngol Head Neck Surg. 2000; 123: 613-616
        • Palta R.
        • Sahota A.
        • Bemarki A.
        • et al.
        Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion.
        Gastrointest Endosc. 2009; 69: 426-433
        • Stack L.B.
        • Munter D.W.
        Foreign bodies in the gastrointestinal tract.
        Emerg Med Clin North Am. 1996; 14: 493-521
        • Chiu Y.H.
        • Hou S.K.
        • Chen S.C.
        • et al.
        Diagnosis and endoscopic management of upper gastrointestinal foreign bodies.
        Am J Med Sci. 2012; 343: 192-195
        • Li Z.S.
        • Sun Z.X.
        • Zou D.W.
        • et al.
        Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China.
        Gastrointest Endosc. 2006; 64: 485-492
        • Bendig D.W.
        • Mackie G.G.
        Management of smooth-blunt gastric foreign bodies in asymptomatic patients.
        Clin Pediatr (Phila). 1990; 29: 642-645
        • Dellon E.S.
        • Liacouras C.A.
        • Molina-Infante J.
        • et al.
        Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference.
        Gastroenterology. 2018; 155: 1022-1033
        • Dellon E.S.
        • Gonsalves N.
        • Hirano I.
        • et al.
        ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).
        Am J Gastroenterol. 2013; 108 (quiz 693): 679-692
        • Desai T.K.
        • Stecevic V.
        • Chang C.H.
        • et al.
        Association of eosinophilic inflammation with esophageal food impaction in adults.
        Gastrointest Endosc. 2005; 61: 795-801
        • Mackenzie S.H.
        • Go M.
        • Chadwick B.
        • et al.
        Eosinophilic oesophagitis in patients presenting with dysphagia—a prospective analysis.
        Aliment Pharmacol Ther. 2008; 28: 1140-1146
        • Prasad G.A.
        • Talley N.J.
        • Romero Y.
        • et al.
        Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study.
        Am J Gastroenterol. 2007; 102: 2627-2632