Food impactions in the esophagus: incidence, causes, and treatment

Food impactions in the esophagus are gastroenterologic emergencies. Their incidence is suspected to increase. Standard therapy is endoscopic removal. According to European guidelines from 2016, gently pushing the food forward with the endoscope is safe and efficient. This has recently been doubted, and a retrograde extraction of the food bolus was supposed to be safer.We retrospectively analyzed all food impactions in our database over 16 years regarding incidence per year, age, sex, underlying disease, method of removal, success rate, and safety.From 2008 to 2024, 99 patients were included. Incidence of food impactions increased logarithmically from one per year to 22 per year (p < 0.001). Seventy-nine patients were male (80%; p < 0.001). Underlying diseases were reflux-associated lesions, eosinophilic esophagitis, pseudo-diverticulosis, hernia, achalasia, candidiasis, and others. Fifty-five were pushed forward prior to 2016, afterwards it were 74 (56% and 75% respectively; p < 0.001). Success rate was 100 percent for all techniques. We observed two minor adverse events in the forward-pushing group vs. one in the extraction group (not significant).Our data confirms that food obstructions are on the rise and that the vast majority of patients are male. There is no typical underlying disease but a wide variety of rare diseases which together form the basis for the increase. Pushing forward is as safe as is extracting the food, so we see no necessity to change the existing guidelines.