Esophagus to Small Intestine
Am J Gastroenterol. 2023;118(10):1787–96
Post-endoscopy care for patients presenting with esophageal food bolus impaction: A population-based multicenter cohort study
Introduction: Esophageal food bolus impactions (FBI) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction but also medical follow-up and treatment for the underlying esophageal pathology. The authors evaluated the appropriateness of post-endoscopy care for patients with FBI and assessed patient-related, physician-related, and system-related factors that may contribute to loss to follow-up.
Methods: They conducted a retrospective, population-based, multicenter cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada, from 2016 to 2018. Appropriate postendoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton-pump inhibitors or endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression.
Results: A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate post-endoscopy care. Half of the patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and among this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including 3 new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio = 7.28, 95% confidence interval: 4.49–11.78, p < 0.001) more likely to receive inappropriate post-endoscopy follow-up and treatment, even after adjusting for age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions.
Discussion: One-quarter of patients presenting with food bolus impaction do not receive appropriate post-endoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.