Esophageal food bolus obstruction: Evaluation of extraction and modified push techniques in 75 cases

Background and Study Aims: 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. Patients and Methods: Seventy-five procedures with soft food bolus obstruct ion were analyzed. If endoscopic extraction failed, or it was determined th at alternative techniques would be effective, food was pushed into the stom ach 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 du ration, including stricture dilation +/- 1 standard deviation), for the ext raction, scope push and Savary push procedures were 32 (+/- 17), 18 (+/- 14 ) and 27 (+/- 15) mm, respectively. No cases of perforation, hemorrhage, ox ygen desaturation, aspiration, or pneumonia occurred. Conclusions: Management of esophageal food bolus obstructions by modified p ush methods and esophageal dilation in the same session appears to be effec tive, efficient and safe. The methods employed should be individualized for each patient. Push methods require experience and judgment.