The "After Hours" Effect and Role of Endoscopy Setting on Outcomes in Patients with Esophageal Food Impaction

Esophageal food impaction (EFI) resulting in obstruction is a gastrointestinal emergency requiring disimpaction by upper endoscopy. Current guidelines recommend emergent intervention within 24 h to reduce risk of complications. However, limited data exist regarding specific factors affecting practice patterns, including timing and setting of endoscopic intervention for EFI.

We conducted a retrospective review of 684 patients who presented with EFI to the emergency department (ED) at three hospitals from 2015-2021. 447 patients met inclusion criteria. We compared hospitalization rates, ED triage-to-endoscopy time, sedation type, endoscopy setting [ED/intensive care unit (ICU), operating room (OR), or endoscopy unit (EU)], and complications for "business hours" (between 8AM and 5PM) and "after hours" procedures (weekends or before 8AM/after 5PM).

Among 509 EFI cases, 67.2% were performed "after hours," and 56.2% occurred in the EU. "After hours" endoscopies were over fourfold more likely to involve moderate sedation (OR 4.35 [1.64-11.54]). Mean ED triage-to-endoscopy time was significantly longer for "business hours" cases (11.3 ± 21.2 h versus 5.4 ± 10.3 h, adjusted p-value = 0.0002). Patients undergoing endoscopy "after hours" were 74% less likely to be hospitalized (0.26 [0.13-0.55]). Although not statistically significant, "after hours" cases had lower complication rates (2.3 versus 4.8%) and in-hospital mortality (0.0% vs 1.2%) compared to "business hours" (p-value ≤ 0.1367 and ≤ 0.1072, respectively).

We found that "after hours" endoscopic disimpactions for EFI did not have increased hospitalizations or increased complications relative to "business hours," contrary to current literature. Our findings underscore the safety, efficacy, and feasibility of "after hours" endoscopic intervention for EFI, which may help shape resource allocation and hospital protocols to improve patient outcomes in the future.