Interventions and equipment

An impacted oesophageal food bolus is an emergency that must be addressed as soon as possible. There are a number of tools available that can be used to relieve oesophageal food impaction, such as the over-the-scope-grasper (OTSG) device shown in the video above.

The following infographic displays ESGE/ESPGHAN recommendations for oesophageal food impaction.

<img src="https://ugc.futurelearn.com/uploads/assets/2f/8d/2f8d9f95-647e-4e50-9d6a-446511538649.png" alt="ESPGHAN recommendations: Consider the removal of impacted food from the oesophagus as an emergency 2 hours from the time of presentation (and ideally from the time of ingestion) in case of symptoms (drooling, neck pain). If the child is asymptomatic an urgent (

Care should be taken for airway protection in all patients undergoing endoscopic foreign body removal and with adequate air insufflation to achieve maximal oesophageal distension. Once stricture has been ruled out, the food bolus may be removed via piecemeal extraction, suction or gentle pushing into the stomach with the help of the endoscope. If the latter is the preferred option, excessive force should be avoided because it may cause perforation.

In all cases, visualisation of the distal oesophagus is recommended to ensure there is no stricture distal to the food bolus. At the same time, oesophageal biopsies should be obtained to assess mucosa for underlying pathology such as EoE.

Devices such as roth nets, polypectomy snares, and rat or alligator tooth forceps are used to relieve oesophageal food impaction.

In case oesophageal stricture or ring is identified after removal of the food bolus in the absence of apparent mucosal inflammation, dilation should be considered during the same session. Endoscopic findings that are suggestive of EoE should be taken into account to perform dilation with extreme caution or even defer it.

Another technique applied recently was an inflatable through-the-scope balloon, which is passed along the side of the oesophageal mucosa beyond the area of impaction in the proximal oesophagus. This was used to successfully pull the food bolus into the mouth, with gentle traction after inflation distal to the impacted food, from where it was removed using alligator forceps. This is illustrated in the schematic below.

^{Diagram showing (A) the impacted foreign body in the proximal oesophagus and (B) its removal by inflating the balloon distal to it. Adapted from Anand, R. et al., 2015 licensed under CC BY 3.0.}

The through-the-scope balloon inflation removal method should only be considered when other methods have failed and only if the food bolus is impacted in the proximal oesophagus, never in the distal.

Over-the-scope-grasper (OTSG)

Even more recently, a new grasping tool designed for endoscopic removal of larger particles attached to any standard gastroscope (over-the-scope grasper, OTSG) was shown to successfully remove food bolus from an adult patient with no procedure-associated complications. You have already seen a video of this device in use at the beginning of this step.

Take a look at the image below, which shows the OTSG in two different grasper positions.

^{Image of OTSG with the grasper open (A) and closed (B) (Brand, M. et al., 2022, licensed under CC BY 4.0).}

The following infographic illustrates the procedure of using an OTSG to remove food bolus from a patient.

Let’s hear from our learners!

Have you had any experience with these methods of food bolus removal? If so, which tools have you found most successful?

Let us know in the comments below.