Safety of delaying endoscopic intervention for complete esophageal soft food bolus impaction

Esophageal soft food bolus obstruction is a common emergency department presentation that requires urgent endoscopic intervention. Although current guidelines recommend intervention within 6 to 12 hours, recent evidence indicates that extending this timeframe has not been associated with worsening clinical outcomes. We aim to investigate the safety of delaying endoscopy beyond 6 hours of triage for complete esophageal food bolus obstructions.

We conducted a multicenter retrospective cohort study evaluating coprimary outcomes of 30-day mortality and dysphagia-related hospitalizations and secondary outcomes of procedural adverse events among patients who underwent early (within 6 hours of triage) and delayed (after 6 hours of triage) endoscopic management of those with triage symptoms consistent with a complete esophageal food bolus impaction.

Mortality was not observed in either the early or delayed cohorts, and there was no difference in rehospitalization (4.4% vs 3.3%, respectively; P = 1). There was a numerical difference in mucosal injury (2.2% vs 13.2%) that was not statistically significant (P = .15). Similar rates of general anesthesia (6.67% vs 6.67%; P = 1) were observed in both cohorts. Patients with delayed management were less likely to have a food bolus visualized (86.7% vs 63.3%; P = .025) and thus less likely to require endoscopic instrumentation. Accessory use was 24.4% and 20% (P = .781) in the early and delayed cohorts, respectively. Multivariable analysis showed no correlation among clinical demographics, presence of eosinophilic esophagitis, or procedural time with mucosal injury. Endoscopic instrumentation was associated with increased but not statistically significant odds of mucosal injury (odds ratio, 5.0; 95% confidence interval, 0.443-58.1; P = .192).

Delaying endoscopic intervention beyond 6 hours of presentation does not result in significantly worse clinical outcomes. These results will help endoscopists risk stratify food bolus cases, possibly delaying intervention until daytime hours when more endoscopy personnel and resources are available.