No association between time to endoscopy and perforation or aspiration pneumonia in oesophageal food bolus impaction: a multicentre retrospective cohort study

Objective European guidelines recommend emergent endoscopy (<6 hours) for completely obstructing oesophageal food bolus impaction and urgent endoscopy (<24 hours) for incomplete obstruction, but the supporting evidence derives largely from mixed foreign body cohorts enriched for sharp objects. We assessed whether time to endoscopy was associated with perforation or radiologically confirmed aspiration pneumonia in patients with suspected complete and incomplete oesophageal food bolus obstruction. Design/Method We performed a multicentre retrospective cohort study across three London hospitals. All oesophagogastroduodenoscopies for suspected food bolus obstruction between 16 September 2022 and 30 November 2025 were identified. Primary outcomes were radiologically confirmed perforation and aspiration pneumonia within 14 days. Results Seventy-two cases were included (mean age 53.2 years, 64% male). Only 2/72 cases (2.8%) underwent endoscopy within 6 hours. Median time to endoscopy was 20.1 hours (IQR 15–27) for all cases. No perforations occurred in the cohort (0/72, 0%). Presumed aspiration pneumonia occurred in 2/72 cases (2.8%); both cases underwent endoscopy >24 hours after presentation (Fisher’s exact p=0.11). Time to endoscopy was not associated with pneumonia (OR per 6-hour increase 1.26, 95% CI 0.63 to 2.07; p=0.39). Conclusion In this modest cohort of predominantly soft oesophageal food bolus impactions, no perforations occurred and presumed aspiration pneumonia was uncommon. Longer time to endoscopy was not associated with presumed aspiration pneumonia, but the small sample size and low event rate limit definitive conclusions regarding procedural timing. These findings should support future larger prospective studies evaluating risk-stratified timing pathways for oesophageal food bolus impaction.