title: An innovative fast track solution for food bolus impaction due to Jackhammer esophagus in an emergency department: the "Nitro-Push Blind Technique" case report.
abstract: BACKGROUND
  In the medical literature are described only few clinical cases of esophageal food bolus impaction due to esophageal motility disorders. Moreover, the management of this condition is highly variable with no evidence in the literature to strongly support a clear defined intervention.
  
  
  METHODS
  In this paper we describe for the first time a case of 53-year-old male with food bolus impaction due to Jackhammer esophagus referred to emergency department. On the basis of the known esophageal past medical history as well as the absence of bones in the bolus, the patient was submitted to a new conservative treatment, the "Nitro-Push Blind Technique".
  
  
  CONCLUSIONS
  The new technique performed with naso-gastric tube thrust after nitrates medication in definite clinical case supported by known functional disease, represents a safe and successful method, with short observational period to minimize exposure to potential morbidity and reduce the inpatient stay in emergency department. It should be recommended, once validated in a larger cohort, as the initial treatment of choice in the selected patients with food boneless bolus impaction in the emergency settings. Indeed, this management provides only minimal deviation from the current practice and is hence technically easy to learn and perform.
authors.affiliation: Unit of Robotic Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, 06049, Spoleto (PG), Italy. marano.luigi@email.it.|Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy. marano.luigi@email.it.
authors.forename: Luigi
authors.identifier: http://orcid.org/0000-0002-9777-9588
authors.initials: L
authors.lastname: Marano
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cecchi
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Chiodo
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gullo
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fiorillo
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Roncetti
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Longaroni
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Gianluca Proietti
authors.initials: GP
authors.lastname: Silvestri
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Lolli
authors.affiliation: Department of Emergency Medicine and Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Via Loreto 3, 06049, Spoleto (PG), Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Nicolic
authors.affiliation: Unit of Robotic Surgery, "San Matteo degli Infermi Hospital" - ASL Umbria 2, 06049, Spoleto (PG), Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Patriti
mesh_terms: D000286:Administration, Sublingual; D004636:Emergency Service, Hospital; D015154:Esophageal Motility Disorders / Q000150:complications*; D005502:Food; D005547:Foreign Bodies / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*
chemical_list: D005996:Nitroglycerin
keywords: Case report; Esophageal food bolus impaction; Jackhammer esophagus; Nutcracker esophagus