To flex or not to flex: oesophageal soft food bolus obstruction in the modern age.

Background: Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic.

Method: The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed.

Results: In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity.

Conclusion: Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance.