Oesophageal Soft Food Bolus Obstruction: A Retrospective Review of the Management of 384 Cases in Two UK Hospitals

TL;DR

This study examines how 384 cases of soft food blockages in the esophagus were managed in two UK hospitals, finding that most cases resolved without surgery and suggesting the need for national guidelines.

Contribution

The study provides real-world data on OSFBO management in the UK, highlighting the effectiveness of conservative treatment and the diagnostic value of post-resolution imaging.

Findings

65% of cases resolved with conservative management, mostly within 24-48 hours.

Rigid oesophagoscopy had a 1.4% complication rate, while flexible oesophagoscopy was also effective.

Post-resolution contrast swallow imaging revealed oesophageal abnormalities in 48% of cases.

Abstract

Objectives

Oesophageal soft food bolus obstruction (OSFBO) is a frequent emergency presentation to otolaryngology, gastroenterology, and general surgery departments. While many cases resolve without intervention, others require urgent endoscopy, with no UK consensus on referral pathways, timing, or technique. This study evaluates the real-world management of OSFBO across two UK hospitals over 12 years, examining rates of conservative resolution, procedural intervention, associated complications, and the diagnostic utility of post-resolution contrast swallow imaging.

Methods

A retrospective review of all adult patients (≥16 years) presenting with OSFBO between August 2008 and August 2020 at one tertiary and one district general hospital was conducted. Sharp or non-organic foreign body cases were excluded. Data were collected from electronic records, anonymized, and analysed using IBM SPSS (IBM Corp., Armonk, NY). Categorical and continuous variables were compared using appropriate statistical tests. Kaplan-Meier survival analysis assessed time to resolution, and logistic regression (visualized via a forest plot) identified predictors of procedural intervention.

Results

Among 384 cases, 65% (n = 249) resolved with conservative management. Of the 135 patients requiring intervention, 58% (n = 70) underwent rigid oesophagoscopy, and 42% (n = 51) had flexible oesophagoscopy. One case of oesophageal perforation occurred following rigid oesophagoscopy (1.4% complication rate). Flexible nasendoscopy dislodged the bolus in 3% (n = 7) of all cases. Hyoscine butylbromide was used in 71% (n = 193), with 32% (n = 62) subsequently requiring intervention, compared to 6% (n = 5) in those not receiving it. Plain radiographs were diagnostic in only 6% (n = 7) of 122 cases. Post-resolution contrast swallow imaging was performed in 20% (n = 75), with 48% (n = 36) revealing oesophageal abnormalities such as webs, achalasia, and strictures. Kaplan-Meier analysis showed most conservative resolutions occurred within 24-48 hours. Regression analysis identified age and absence of hyoscine as significant predictors of intervention.

Conclusions

The majority of OSFBO cases resolve without the need for invasive procedures. Rigid and flexible oesophagoscopy are both effective, though rigid carries a higher risk of complications. Flexible nasendoscopy may offer a low-risk, bedside option for select patients. Post-resolution contrast swallow studies have a high diagnostic yield and should be considered in follow-up. These findings support the need for national guidelines and further prospective research into pharmacological and procedural strategies for OSFBO.

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