Association between time from esophageal food impaction to endoscopy and adverse events

Background and Aims Guidelines recommend emergent or urgent esophagogastroduodenoscopy (EGD) for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We aimed to determine whether EFI-to-EGD time was associated with adverse events. Methods In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extra-esophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extra-esophageal adverse events requiring ICU admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events. Results Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older, more likely to have an esophageal motility disorder, tolerate secretions at presentation, and have a higher ASA score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (OR 1.00, 95% CI 0.97-1.04 for one-hour increments; OR 1.03, 95% CI 0.86-1.24 for six-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders. Conclusions Since time from EFI event to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary and other considerations may determine EGD timing. Guidelines recommend emergent or urgent esophagogastroduodenoscopy (EGD) for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We aimed to determine whether EFI-to-EGD time was associated with adverse events. In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extra-esophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extra-esophageal adverse events requiring ICU admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events. Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older, more likely to have an esophageal motility disorder, tolerate secretions at presentation, and have a higher ASA score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (OR 1.00, 95% CI 0.97-1.04 for one-hour increments; OR 1.03, 95% CI 0.86-1.24 for six-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders. Since time from EFI event to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary and other considerations may determine EGD timing.