Department of Internal Medicine, Henry Ford Hospital, Detroit, USA.
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, USA.
Dig Dis Sci. 2024 Oct;69(10):3835-3843. doi: 10.1007/s10620-024-08600-9. Epub 2024 Sep 19.
Esophageal food impaction (EFI) is a common complaint of patients presenting to the emergency department. EFI requires urgent evaluation by the gastroenterology service and often necessitates esophagogastroduodenoscopy (EGD) for management. Timing of EGD in patients with EFI that does not improve with medical management remains a point of contention. We aim to evaluate outcomes of EFI in the context of time to intervention.
A retrospective cohort study was performed among patients who presented to a multicenter health system with EFI between 2018 and 2022. Patients with EFI that did not resolve after medical management and required EGD were included. Outcome analysis evaluated rates of complications and hospitalizations.
Two hundred eighty sis unique patient presentations were included. 175 (61.2%) of patients underwent EGD within six hours of presentation, 59 (20.6%) underwent EGD six to twelve hours after presentation, and 52 (18.2%) underwent EGD beyond twelve hours after presentation. Complication rates did not differ between patients depending on timing of EGD (p = 1.000). Admission rates were higher among patients in whom EGD was performed longer after presentation (p = 0.003). Complication rates were higher among patients with advanced age (p = 0.037), prior impaction (p = 0.004), and those who have not received glucagon (p = 0.007).
Timing of EGD after presentation in patients with EFI was not associated with a difference in complication rates. Delayed intervention was associated with a higher rate of hospitalization which should be taken into consideration when assessing the cost of EFI to the healthcare system.
食管食物嵌塞（EFI）是急诊科患者常见的主诉。EFI 需要由胃肠病学服务团队进行紧急评估，通常需要进行食管胃十二指肠镜检查（EGD）以进行治疗。对于经药物治疗后未改善的 EFI 患者，行 EGD 的时机仍然存在争议。我们旨在评估 EFI 患者的治疗结果与干预时间之间的关系。
对 2018 年至 2022 年期间在多中心医疗系统就诊的 EFI 患者进行回顾性队列研究。纳入经药物治疗后未缓解且需要 EGD 的 EFI 患者。对结局进行分析，评估并发症和住院率。
共纳入 286 例患者。175 例（61.2%）患者在就诊后 6 小时内行 EGD，59 例（20.6%）患者在就诊后 6 至 12 小时内行 EGD，52 例（18.2%）患者在就诊后 12 小时后行 EGD。根据 EGD 时间，不同患者的并发症发生率无差异（p=1.000）。就诊后行 EGD 时间较长的患者的住院率较高（p=0.003）。高龄（p=0.037）、有既往嵌塞史（p=0.004）和未使用胰高血糖素的患者（p=0.007）的并发症发生率更高。
EFI 患者就诊后行 EGD 的时间与并发症发生率无相关性。延迟干预与较高的住院率相关，在评估 EFI 对医疗系统的成本时应考虑这一点。
