Introduction

Danish national guidelines recommend a diagnostic upper endoscopy within 2 weeks after food bolus obstruction (FBO). Firstly to search for possible upper gastro-intestinal (GI) cancer (national cancer guideline), and if cancer is excluded to sample 8 biopsies to exclude eosinophilic oesophagitis (EoE) (EoE guideline). In the clinical work in our Department of Emergency Medicine in Denmark there is a growing suspicion that these nationale guidelines are not always followed.

Aims & Methods

The aims of this study were to 1) describe the causes of FBO, 2) to determine the proportion of patients who underwent upper endoscopy with biopsies according to guideline, and 3) to identify ICD10 diagnosis and procedure codes applied to the hospital visits due to FBO in the North Denmark Region (NDR). This was a registry based study og the entire population of the North Denmark Region of 580,000 citizens. For all acute hospital visits in the NDR in 2021, medical registries were used to find patients with FBO, and their medical records were reviewed. All hospital visits with ICD 10 codes possibly reflecting FBO, and a sample of 14400 hospital visits with unspecific ICD codes (R and Z codes) were screened for possible FBO. Diagnosis, follow up, and treatment were recorded for all patients with FBO.

Results

Of 1886 hospital visits where registry ICD codes possibly reflected FBO 8.4% were due to FBO, while FBO were present in 0.028% in a sample of 14400 hospital visits with ICD codes of unspecific nature. The median age for a patient presenting with FBO at the hospital was 66.0 (49.8-81.0) years, and 55 % had experienced FBO before. Effective treatment of FBO only involved endoscopic removal in half of patients​​​​Thirty percent did not undergo upper endoscopy within 2 weeks of the hospital visit (upper cancer guideline), and 51% were never biopsied in the oesophagus (EoE guideline). Most patients (65.1%) were never diagnosed with a cause of FBO.

Conclusion

More than half of patients hospitalized due to FBO in NDR in 2021 were never diagnosed with a cause. In one third the national cancer guidelines were not followed, and in half of the cohort EoE guidelines were not followed. There is a real risk of undetected upper GI cancers and EoE as consequence and the area needs focus in Denmark to improve patient treatment and prevent new FBO.

References

Andersen IB, Bremholm L, Havelund T, Jørgensen SP, Lund Krarup A, Mohammadi M, et al. Eosinofil øsofagitis [Internet]. Dansk Selskab for Gastroenterologi og Hepatologi. 2020 [cited 2023 Mar 13]. Available from: https://dsgh.dk/wp-content/uploads/2022/06/EoE.pdf
6. Sundhedsstyrelsen. Pakkeforløb for kræft i spiserør, mavesæk og mavemund [Internet]. 2016 [cited 2023 Mar 26]. p. 11. Available from: https://www.sst.dk/-/media/Udgivelser/2016/Kraeft-Spiseroer-mavesaek-mavemund/Pakkeforloeb-for-kraeft-i-spiseroer-mavesaek-og-mavemund.ashx?sc_lang=da&hash=6645435FD019F6FCAD974D027B4402DB