Review of endoscopic procedure, findings and diagnosis related to esophageal food bolus impaction in a terciary hospital: a retrospective study

Aims Food bolus impaction (FIB) is a common emergency in gastroenterology, requiring in many cases of endoscopic retrieval. It is associated with chronic conditions such as eosinophilic esophagitis (EoE), Schatzki’s ring (SR) or peptic strictures, with a higher risk of recurrence. The aim of this study is to analyze the endoscopic findings during urgent endoscopy due to FIB and the cause underlying those episodes.

Methods A retrospective review of our hospital’s endoscopy database was conducted from January 2010 to December 2021. All upper endoscopy with diagnosis of esophageal foreign body were reviewed (n=743), selecting those cases with food bolus impaction (n=372).

Results We included 372 cases of FBI. Mean age was 50 years old (yo) (SD±19). Seventy percent of all endoscopies were performed in men. Respect to clinical data, 22.9% (n=85) had personal history of asthma or extrinsic allergy, 9.7% (n=36) of gastro-esophageal surgery, 16.7% (n=62) of neurologic disorders and 6.72% (n=25) of esophageal or laryngo-pharynx neoplasia. Personal history of previous FIB was registered in 16% (n=58) patients and previous diagnosis of EoE, SR, strictures or achalasia were registered in 3.2% (n=12), 6.18% (n=23) and 0.8%(n=3) respectively. The most frequent allocation for FIB was distal esophagus (57%, n=211). In 54.7% (n=203) of all cases was performed the bolus retrieval while in 21,8% (n=79) the bolus was pushed to the stomach. In 78 cases (21.3%) the bolus advanced spontaneously with insufflation. After removal of FIB, according to endoscopic findings, SR was described in 35% (n=131) of all endoscopies, benign stenosis in 13.7% (n=51) and imaging compatible with EoE in 16% (n=59). In a quarter of all endoscopies was not possible to identify a structural cause for FIB. As a consequence of FIB, the most common finding was mucosal inflammation (MI) (n=82) followed by ulcers (n=55). Active bleeding during the endoscopy was described in 27 cases, 10 of them related to MI, 9 due to ulcers and 5 of them because of mucosal lacerations. Six cases of pneumonia were registered, and 2 cases of FIB evolved to esophageal perforation. Only one death was registered, due to pneumonia in the elderly. After the FIB episode, the most common diagnosis for FIB was SR (32%, n=119), EoE (19.4%, n=72) and benign strictures (11.3%, n=42). In patients under 40 yo (n=92), the most frequent diagnosis is EoE (53%, n=49) followed by SR (17.4% n=16) and strictures (4%, n=4). In the group of age between 40-65 yo the most frequent cause of FIB is SR (31.1%, n=42) followed by EoE (17.3%, n=23) and benign strictures (13%, n=17). In the elderly group, above 65 yo, the most frequent cause of FIB are SR (42%, n=61), strictures (14.5%, n=21) and hiatal hernia (6.9%, n=10). [1] [2]

Conclusions FIB is more common in men. FIB most frequent location is distal esophagus. In most cases is necessary the removal of the impacted bolus. Complications are infrequent and mild in the vast majority of cases. The most frequent cause of FIB is SR, although EoE is more prevalent under 40 yo.

Publication History

Article published online:
15 April 2024

• References

• 1 Gurala D, Polavarapu A, Philipose J. et al. Esophageal Food Impaction: A Retrospective Chart Review. Gastroenterology Res 2021; 14: 173-8
• 2 Schupack DA, Lenz CJ, Geno DM. et al. The evolution of treatment and complications of esophageal food impaction. United European Gastroenterol J 2019; 7: 548-56