An endoscopic strategy for oesophageal food bolus impactions: a multicentre retrospective study of 750 patients over a decade.

Abstract

Background: The management of oesophageal food bolus impactions (OFBIs) has seen a growing preference for the use of distal attachment caps over traditional devices such as nets, snares and grasping forceps.

Aim: Our aim was to evaluate the outcomes of procedural efficiency and cost implications of different endoscopic strategies.

Methods: This was a retrospective multicentre review of all adults with soft OFBIs between 2011 and 2021. Data were collected using patient medical records, with 750 patients meeting the inclusion criteria.

Results: The mean age was 56 years, with a predominance of males (72.3%). Eosinophilic esophagitis (EoE) was the primary cause of OFBI from 2019 onwards, replacing reflux esophagitis. Medical management was attempted in 75.2% of patients. The 'push' technique showed significantly shorter procedure durations compared to 'pull' strategies (25.2 ± 19.6 vs 37.0 ± 24.7 min; P < 0.001). Cap-based pull strategies resulted in shorter procedure times (30.7 ± 16.0 vs 40.2 ± 28.0 min; P = 0.002), higher en-bloc removal rates (80.4% vs 19.8%; P < 0.001) and fewer instruments used (1.0 vs 1.5; P < 0.001) compared to conventional strategies without a difference in adverse events. Multivariable regression confirmed cap-assisted techniques, push strategy, and sedation (vs intubation) were independently associated with significantly shorter intervention times. Cost modelling estimated a per-case saving of $439.98 with cap use.

Conclusion: Cap-assisted endoscopy offers superior clinical efficacy and cost-effectiveness compared to conventional methods. These findings support the routine use of cap-assisted techniques and suggest that a push-based strategy could be considered as the initial approach in the endoscopic management of food bolus impactions.