Introduction
Oesophageal food bolus impaction [OFBI] is a common presentation to emergency room [ER] and often requires endoscopic intervention. We aimed to describe the incidence of OFBI in Canterbury, New Zealand and examine factors predicting the need for endoscopic intervention and complications in the population-based cohort.
Aims & Methods
All ER presentations of OFBI in Canterbury between October 2018 and August 2023 were included. Population data for the Canterbury population was obtained from Statistics NZ. Ethnicity was defined according to hospital records based on patients’ self-identification. Endoscopic intervention was defined as the presence of bolus during the endoscopy requiring any endoscopic manoeuvre for clearance. Complications were defined as unsuccessful attempts requiring a repeat procedure or procedure-related injuries.
| Total (n = 187) |
| Age (years) | Mean 55
Median 54.9 |
Gender
- Male (%) : Female (%) | 113 (60.4) : 74 (39.6) |
Ethnicity
- European (%) : Non-European (%) | 163 (87.2) : 24 (12.8) |
| Cause of oesophageal impaction (%) | EoE 42 (22.5)
Stricture 43 (23)£
Other 15 (8)*
Idiopathic/unknown 87 (46.5)¥ |
| Food type (%) | Meat 141 (86.5)
Non-meat 46 (24.5) |
Spontaneous clearance of food bolus clinically,
without endoscopy performed (inpatient or outpatient) (%) | 42 (22.5) |
| Spontaneous clearance of food bolus diagnosed on endoscopy as an inpatient (%) | 37 (19.8) |
| Inpatient endoscopic intervention required (%) | 92 (49.2) |
| Total complications (%) | 8 (4.3) |
£ cause of impaction from Schatzi ring or benign esophageal stricture
* cause of impaction from severe reflux oesophagitis (Los Angeles Grade C or D), esophageal dysmotility, malignant stricture, or esophageal candidiasis
¥ no cause for impaction found; either no endoscopy performed as an inpatient or outpatient or no pathology found on endoscopy
Results
There were 187 ER presentations of OFBI between October 2018 and August 2023. Clinical characteristics of the population-based cohort are presented in Table 1.
The average annual incidence of ER presentations of OFBI in Canterbury region between 2019 – 2022 was 5.82 per 100,000 population (95% CI 3.96-7.68/100,000). The incidence of ER presentations of OFBI in Europeans and non-Europeans over the same period was 8 per 100,000 European population (95% CI 5.27-10.73/100,000) and 1.94 per 100,000 non-European population (95% CI 0.15-3.73/100,000).
A total of 92 cases (49%) required endoscopic intervention. Factors predicting the need for endoscopic intervention were meat bolus [p= 0.01], stricture [p<0.01], and early endoscopy performed <12hrs [p<0.01]. There were only 8 complications. Predictors with a trend associated with complications were after-hours presentation [p=0.06] and early endoscopy performed <6hrs [p=0.06].
Conclusion
Our population-based cohort showed a significantly higher incidence of ER presentations of OFBI in Europeans than in non-European ethnic groups. Factors predicting the need for endoscopic intervention were meat bolus, stricture and early endoscopy. After-hours presentation and early endoscopy <6hrs showed a trend towards a higher risk of complications. The results suggest that a delayed approach may be associated with a higher chance of spontaneous clearance and a lower risk of complications, although further study is needed.
Disclosure
Not applicable
