TY - JOUR
T1 - Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting
T2 - An Evidence-Based Review
AU - Long, Brit
AU - Koyfman, Alex
AU - Gottlieb, Michael
N1 - Publisher Copyright:
© 2019
PY - 2019/5
Y1 - 2019/5
N2 - Background: Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine–focused literature concerning these conditions. Objective of the Review: This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. Discussion: Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. Conclusions: This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
AB - Background: Patients with esophageal foreign bodies or food bolus impaction may present to the emergency department with symptoms ranging from mild discomfort to severe distress. There is a dearth of emergency medicine–focused literature concerning these conditions. Objective of the Review: This narrative review provides evidence-based recommendations for the assessment and management of patients with esophageal foreign bodies and food bolus impactions. Discussion: Esophageal foreign bodies and food bolus impaction are common but typically pass spontaneously; however, complete obstruction can lead to inability to tolerate secretions, airway compromise, and death. Pediatric patients are the most common population affected, while in adults, edentulous patients are at greatest risk. Foreign body obstruction and food bolus impaction typically occur at sites of narrowing due to underlying esophageal pathology. Diagnosis is based on history and examination, with most patients presenting with choking/gagging, vomiting, and dysphagia/odynophagia. The preferred test is a plain chest radiograph, although this is not required if the clinician suspects non-bony food bolus with no suspicion of perforation. Computed tomography is recommended if radiograph is limited or there are concerns for perforation. Management requires initial assessment of the patient's airway. Medications evaluated include effervescent agents, glucagon, calcium channel blockers, benzodiazepines, nitrates, and others, but their efficacy is poor. Before administration, shared decision making with the patient is recommended. Endoscopy is the intervention of choice, and medications should not delay endoscopy. Early endoscopy for complete obstruction is associated with improved outcomes. Conclusions: This review provides evidence-based recommendations concerning these conditions, focusing on evaluation and management.
KW - complete obstruction
KW - endoscopy
KW - esophageal foreign body
KW - food bolus impaction
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U2 - 10.1016/j.jemermed.2019.01.025
DO - 10.1016/j.jemermed.2019.01.025
M3 - Article
C2 - 30910368
AN - SCOPUS:85063113356
SN - 0736-4679
VL - 56
SP - 499
EP - 511
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 5
ER -