Use of enzymes for meat impactions in the esophagus

A case is reported in which papain was satisfactorily used to treat a patient who had meat impacted in his esophagus. The English literature pertaining to the usage of proteolytic enzymes in treating esophageal meat impaction is reviewed. (Two perforations and deaths have been reported in association with the usage of this technique. Ninety instances of employment of the technique were reported in the literature. The method has doubtlessly been used in numerous unreported instances. At present it is unrealistic to conclude that the method is safer or more dangerous than routine endoscopic removal of impacted meat. Several conclusions may be drawn: 1. Enzymes should not be used if the physician has any reason to suspect that a bone may be lurking within the impacted meat. 2. Best results using any enzyme will be obtained if pooled secretions above the impacted meat are first removed with a nasogastric tube. The enzyme solution may also be administered through the nasogastric tube when the physician is certain of the tube's position. 3. Extreme caution is mandatory during esophagoscopy for removal of a meat impaction after unsuccessful employment of enzymes. Removal of pooled enzyme in the esophagus should be attempted prior to doing esophagoscopy on impacted meat persisting after a course of enzymatic treatment. We would advocate nasogastric tube suctioning, and possibly even esophageal lavage for this purpose. 4 A contrast study of the esophagus should be done after any meat impaction has occurred to rule out otherwise silent esophageal pathology which may have precipitated the impaction.