October 1st, 2010
Esophageal food impaction: Are you a secret pusher?
I, like most endoscopists, remember being told that you should never push an esophageal food impaction into the stomach but instead all food should be removed first, then the cause of the impaction determined and treated.
Well I suspect that most endoscopists do what I do and that is try and safely push the impaction into the stomach, as removal of the bolus is difficult and frankly more dangerous in my opinion, than a careful attempt at a “push”. In order to remove the impaction we have to basket it, snare it, grasp it, put an overtube in or combine and or perform other potentially harmful maneuvers. On the other hand, gently sliding by the impaction keeping the esophageal wall in view usually results in the impaction being pushed or dragged into the stomach without the risk of the maneuvers mentioned above.
So I confess-I am a pusher. How many of you out there are pushers and what has been your experience of going against endoscopic dogma and pushing gently or sliding by to remove impactions?
5 Responses to “Esophageal food impaction: Are you a secret pusher?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
Biography | Disclosures | Summaries
Learn more about Gut Check on Gastroenterology.
NEJM Resident 360 Curbside Consults Podcast- How the Pediatric Boards Are Made with Dr. Andrew Dwyer
- Global Health, GLocal Health, and the Indian Health Service with Dr. Adriann Begay
- Immune Checkpoint Inhibitors with Dr. Kerry Reynolds
- Management of Acute Coronary Syndrome in Older Adults with Dr. Abdulla Damluji
- Culinary Medicine with Dr. Jaclyn Albin and Milette Siler, RD
Thanks for posting this. I’m with you. It’s safer, quicker and less disruptive for the patients to push the food into the stomach rather than using potentially injurious overtubes or intubating patients.
This is a great question. I also push the impact food, but I first, if I could, I make small pieces.
Agree, I am a cautious pusher, I was more aggressive until I caused a tear (I pushed too hard. The patient fortunately, recovered without surgery). A reminder that every procedure has potential complications. Perhaps the key word was “gentle”.
One of my patients recently saw one of the top gastroenterologist in Rabat, Morocco urgently. This was for a piece of meat lodged in the esophagus. He easily pushed it through to the stomach. So, there’s some international support for the idea.
I guess the key to this is ‘gentle’ pressure. I have worked in UK and Australia and the first choice is to gently push it into the stomach with the scope. If that is not possible, using a 3 pronged forceps (with curled ends) would be helpful in breaking the food into smaller pieces without causing mucosal injury.
If these fail, obviously taking the food bolus is the best choice and obviously there are many thechniques available for this.
This begs the question whether you need to intubate a patient with oesophageal food bolus obstruction and the answer needs to be almost always!