Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA.
Division of Gastroenterology, Department of Medicine, Dignity Health - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Dis Esophagus. 2020 Jan 16;33(1). doi: 10.1093/dote/doz084.
This study aimed to determine the rate and safety of immediate esophageal dilation for esophageal food bolus impaction (EFBI) and evaluate its impact on early recurrence (i.e. prior to interval esophageal dilation) from a large Midwest US cohort. We also report practice patterns among community and academic gastroenterologists practicing in similar settings. We identified adult patients with a primary discharge diagnosis for EFBI from January 2012 to June 2018 using our institutional database. Pregnant patients, incarcerated patients, and patients with esophageal neoplasm were excluded. The primary outcome measured was rate of complications with immediate esophageal dilation after disimpaction of EFBI. Secondary outcomes were recurrence of food bolus impaction prior to scheduled interval endoscopy for dilation, practice patterns between academic and private gastroenterologists, and adherence to follow-up endoscopy. Two-hundred and fifty-six patients met our inclusion criteria. Esophageal dilation was performed in 46 patients (18%) at the time of disimpaction. A total of 45 gastroenterologists performed endoscopies for EFBI in our cohort. Twenty-five (62%) did not perform immediate esophageal dilation, and only 5 (11%) performed immediate dilation on greater than 50% of cases. Academic gastroenterologists performed disimpaction of EFBI for 102 patients, immediate dilation as performed in 20 patients and interval dilation was recommended in 82 patients. Of these 82, only 31 patients (38%) did not return for interval dilation. Four patients who did not undergo immediate dilation, presented with recurrent EFBI prior to interval dilation, within 3 months. None of the patients had complications. Complications with immediate esophageal dilation after disimpaction of EFBI are infrequent but are rarely performed. Failure of immediate dilation increases the risk of EFBI recurrence. Given poor patient adherence to interval dilation, immediate dilation is recommended.
本研究旨在确定即时食管扩张治疗食管食物团嵌塞（EFBI）的速率和安全性，并评估其对早期复发（即在间隔食管扩张之前）的影响，该研究来自美国中西部的一个大型队列。我们还报告了在类似环境中执业的社区和学术胃肠病学家的实践模式。我们使用我们的机构数据库，从 2012 年 1 月至 2018 年 6 月，确定了有 EFBI 主要出院诊断的成年患者。排除了孕妇、被监禁的患者和患有食管肿瘤的患者。主要测量的结果是 EFBI 解除嵌塞后立即进行食管扩张的并发症发生率。次要结果是在计划间隔内镜扩张之前食物团嵌塞的复发率、学术和私人胃肠病学家之间的实践模式以及对随访内镜的依从性。256 名患者符合我们的纳入标准。在 46 名患者（18%）解除嵌塞时进行了食管扩张。在我们的队列中，共有 45 名胃肠病学家为 EFBI 进行了内镜检查。25 名（62%）未进行即时食管扩张，只有 5 名（11%）在超过 50%的情况下进行即时扩张。学术胃肠病学家对 102 名患者进行了 EFBI 解除嵌塞，对 20 名患者进行了即时扩张，并建议对 82 名患者进行间隔扩张。在这 82 名患者中，只有 31 名（38%）未返回进行间隔扩张。4 名未进行即时扩张的患者在间隔扩张前 3 个月内出现 EFBI 复发。没有患者出现并发症。EFBI 解除嵌塞后立即进行食管扩张的并发症并不常见，但很少进行。即时扩张失败会增加 EFBI 复发的风险。鉴于患者对间隔扩张的依从性较差，建议进行即时扩张。
