Management of food bolus impaction

In our first case, a young man had a turkey bone stuck in his throat. Although he was able to speak, he was struggling to swallow his saliva. We asked our #FGDebate participants whether this patient should first try a fizzy drink, glucagon or head to the emergency department for further assessment. While the majority advised the patient to go to the hospital (80%), others recommended a fizzy drink or glucagon, which led to the discussion of investigations and management of patients with a food bolus obstruction.

Food bolus impactions tend to occur in the oesophagus, with the most common causes being meat pieces or bones in the Western world and fish bones in Asia. The sharp edges of meat bones have a greater chance of perforation than soft food obstructed in the oesophagus. Thus, it is important to arrange either a CT scan or at least a chest X-ray prior to undertaking an oesophago-gastro-duodenoscopy (OGD).1 Ideally, endoscopic assessment should be undertaken within 12–24 hours following impaction to reduce the risk of complications, which include perforation, retropharyngeal abscess and/or fistula formation. Endoscopic assessment should be carried out more urgently, however, if the patient is unable to swallow their saliva. While a trial of glucagon or fizzy drinks is still commonly practised in the emergency department setting, there is limited evidence to support their use and the potential risks of aspiration and/or perforation …