Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases.
OBJECTIVE
Endoscopic extraction is the standard method of treating esophageal food bolus obstructions. The efficacy, efficiency, and safety of various techniques used over a 12-year period were evaluated.


METHODS
Seventy-five procedures with soft food bolus obstruction were analyzed. If endoscopic extraction failed, or it was determined that alternative techniques would be effective, food was pushed into the stomach by: a) the endoscope tip, with or without a guide wire; or b) the wire-guided Savary dilators. The duration of the procedures included therapeutic Savary dilation (in 61 of 75 cases).


RESULTS
Food bolus obstruction was associated with peptic strictures (69%), Schatzki's rings (19%), and tight fundoplications (3 %). No narrowing was seen in 9%. Extraction, scope push and Savary push methods were successful in seven of 16, 48 of 48, and 20 of 20 attempts, respectively. The mean duration, including stricture dilation (+/- 1 standard deviation), for the extraction, scope push and Savary push procedures were 32 (+/- 17), 18 (+/- 14) and 27 (+/- 15) mm, respectively. No cases of perforation, hemorrhage, oxygen desaturation, aspiration, or pneumonia occurred.


CONCLUSIONS
Management of esophageal food bolus obstructions by modified push methods and esophageal dilation in the same session appears to be effective, efficient and safe. The methods employed should be individualized for each patient. Push methods require experience and judgment.
Weinstock
L B
LB
Dept. of Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
Shatz
B A
BA
Thyssen
S E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation; D016145:Endoscopy, Digestive System / Q000379:methods*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005502:Food; D005547:Foreign Bodies / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018583:Pliability; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome