Glucagon Is a Safe and Inexpensive Initial Strategy in Esophageal Food Bolus Impaction.
BACKGROUND
Controversy exists about the utility of pharmacologic agents and endoscopic technique used for esophageal food bolus impaction.


OBJECTIVE
To evaluate the utility of glucagon and the technique used for endoscopic removal, including the rate of success and the adverse events of the techniques.


METHODS
The database of the largest healthcare provider in southeastern Wisconsin was retrospectively reviewed for patients presenting with esophageal food bolus impaction. Data extracted included glucagon administration and its success rate, outcome of radiographic studies, and the endoscopic method of removal and adverse events associated with it, including 30-day mortality.


RESULTS
A total of 750 patients were identified with food bolus impaction from 2007 to 2012. Glucagon was administered in 440 patients and was successful in 174 (39.5%). Endoscopic removal was performed in 470 patients and was successful in 469 (99.8%). The push technique was utilized in 209 patients, reduction in the bolus size by piecemeal removal followed by the push technique was utilized in 97 patients, and the pull technique was utilized in 107 patients. There were no perforations with endoscopic removal. Only 4.5% of the X-rays performed reported a possible foreign body within the esophagus. Glucagon was a significantly less-expensive strategy than endoscopic therapy (p < 0.0001).


CONCLUSIONS
Glucagon is low cost, is moderately effective, and may be considered as an initial strategy. Endoscopic removal regardless of technique is safe and effective. The yield of radiography is poor in the setting of food bolus impaction.
Department of Gastroenterology, Aurora Health Care, 1218 W. Kilbourn Ave, Suite 404, Milwaukee, WI, 53233, USA. haas.jasonm@gmail.com.|Ferrell Duncan Clinic, 1001 E. Primrose St, Springfield, MO, 65807, USA. haas.jasonm@gmail.com.
Jason
J
Haas
Department of Gastroenterology, Aurora Health Care, 1218 W. Kilbourn Ave, Suite 404, Milwaukee, WI, 53233, USA. julia.leo@aurora.org.
Julia
J
Leo
Department of Gastroenterology, Aurora Health Care, 1218 W. Kilbourn Ave, Suite 404, Milwaukee, WI, 53233, USA. nvakil@wisc.edu.|Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. nvakil@wisc.edu.|, 36500 Aurora Dr, Summit, WI, 53066, USA. nvakil@wisc.edu.
Nimish
N
Vakil
D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004945:Esophagoscopy / Q000191:economics / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005502:Food; D005547:Foreign Bodies / Q000191:economics / Q000628:therapy*; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D005934:Glucagon / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use
D005765:Gastrointestinal Agents; D014665:Vasodilator Agents; D001569:Benzodiazepines; D005934:Glucagon; D005996:Nitroglycerin
Dysphagia; Endoscopy; Food bolus impaction; Foreign body; Glucagon