Skip to main content
SpringerLink
Log in

Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Esophageal food impaction (EFI) is a common GI emergency. Push and pull methods are used currently for EFI retrieval. We aim to review current available literature to compare success rates and evaluate adverse event rates of the two techniques.

Methods

A comprehensive literature search was performed using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, SciELO and Global Index Medicus. Odds ratio (OR) with 95% confidence interval (CI) was calculated when comparing the dichotomous variables. We aimed to evaluate technical success and adverse events for EFI comparing push and pull technique on single arm and comparator analysis.

Results

The search strategy yielded a total of 126 articles. 18 studies with 3528 participants were included. The technical success rate was 97.5% (CI 96.6–99.2%) in the push and 88.4% (CI 72.8–98.7%) in the pull technique with no statistical difference on comparator analysis. Overall rate of adverse events was 4.03% (CI 0.9–5.0%) in the push technique and 2.22% (CI 0–2.9%) in the pull technique with no statistical difference on comparator analysis (OR 95% CI 0.464–2.782, p = 0.78, I2 = 31.54%). There was no statistical difference between rate of lacerations and perforations either between the two techniques.

Conclusion

Both techniques have acceptable clinical outcomes which appear within standard of care. Operator experience and individual clinical scenarios should guide decision-making regarding technique selection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gurala D, Polavarapu A, Philipose J et al. Esophageal food impaction: a retrospective chart review. Gastroenterology Res. 2021;14:173–178.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fung BM, Sweetser S, Wong Kee Song LM, Tabibian JH. Foreign object ingestion and esophageal food impaction: An update and review on endoscopic management. World J Gastrointest Endosc. 2019;11:174–192.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39–51.

    Article  CAS  PubMed  Google Scholar 

  4. Ntuli Y, Bough I, Wilson M. Recognising eosinophilic oesophagitis as a cause of food bolus obstruction. Frontline Gastroenterol. 2020;11:11–15.

    Article  PubMed  Google Scholar 

  5. Hiremath GS, Hameed F, Pacheco A, Olive A, Davis CM, Shulman RJ. Esophageal food impaction and eosinophilic esophagitis: a retrospective study, systematic review, and meta-analysis. Dig Dis Sci. 2015;60:3181–3193.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Magalhães-Costa P, Carvalho L, Rodrigues JP et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: an evidence-based review article. GE Port J Gastroenterol. 2015;23:142–152.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ko HH, Enns R. Review of food bolus management. Can J Gastroenterol. 2008;22:805–808.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Smith MT, Wong RK. Esophageal foreign bodies: types and techniques for removal. Curr Treat Options Gastroenterol. 2006;9:75–84.

    Article  PubMed  Google Scholar 

  9. Vicari JJ, Johanson JF, Frakes JT. Outcomes of acute esophageal food impaction: to push or pull? Gastrointest Endosc. 1999;49:AB113–AB113.

    Google Scholar 

  10. Wahba M, Habib G, Mazny AE et al. Cap-assisted technique versus conventional methods for esophageal food bolus extraction: a comparative study. Clin Endosc. 2019;52:458–463.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shaffer RD, Klug T. A comparative study of techniques for esophageal foreign body removal with special emphasis on meat bolus obstruction. Wis Med J. 1981;80:33–36.

    CAS  PubMed  Google Scholar 

  12. Berggreen PJ, Harrison E, Sanowski RA, Ingebo K, Noland B, Zierer S. Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc. 1993;39:626–630.

    Article  CAS  PubMed  Google Scholar 

  13. Longstreth GF, Longstreth KJ, Yao JF. Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc. 2001;53:193–198.

    Article  CAS  PubMed  Google Scholar 

  14. Weinstock LB, Shatz BA, Thyssen SE. Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases. Endoscopy. 1999;31:421–425.

    Article  CAS  PubMed  Google Scholar 

  15. Page MJ, Moher D, Bossuyt PM et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. Bmj. 2021;372:n160.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schupack DA, Lenz CJ, Geno DM et al. The evolution of treatment and complications of esophageal food impaction. United Eur Gastroenterol J. 2019;7:548–556.

    Article  Google Scholar 

  17. Haas J, Leo J, Vakil N. Glucagon is a safe and inexpensive initial strategy in esophageal food bolus impaction. Dig Dis Sci. 2016;61:841–845.

    Article  CAS  PubMed  Google Scholar 

  18. Sengupta N, Tapper EB, Corban C, Sommers T, Leffler DA, Lembo AJ. The clinical predictors of aetiology and complications among 173 patients presenting to the emergency department with oesophageal food bolus impaction from 2004–2014. Aliment Pharmacol Ther. 2015;42:91–98.

    Article  CAS  PubMed  Google Scholar 

  19. Kerlin P, Jones D, Remedios M, Campbell C. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol. 2007;41:356–361.

    Article  PubMed  Google Scholar 

  20. DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45:139–145.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Krill T, Samuel R, Vela A et al. Outcomes of delayed endoscopic management for esophageal soft food impactions. Gastrointest Endosc. 2020;91:806–812.

    Article  PubMed  Google Scholar 

  22. Cavaliere K, Berkowitz J, Melnyk JL et al. Practice patterns in patients admitted for denovo acute food impaction: a multi-center retrospective study. Am J Gastroenterol. 2019;114:S219.

    Article  Google Scholar 

  23. McMahon CW, Zafar Y, Clarktson CW, Gasparovich V, Clarkston WK. A retrospective review of esophageal food impactions in a multi-center health care system: etiology, adherence to published guidelines, and complications. Gastrointest Endosc. 2018;87:288.

    Article  Google Scholar 

  24. Abdelrahman A, Phull PS. Endoscopic management and outcomes for patients with food bolus obstruction. Gut. 2018;67:A12.

    Google Scholar 

  25. Satchwell J, Grimpen F. Outcomes of endoscopy for food bolus impaction: 6 years of experience at a tertiary hospital. J Gastroenterol Hepatol (Australia). 2017;32:50.

    Google Scholar 

  26. Sharma P, Olivier S, Kwak YE, Sanchez M, Masoud A. Glucagon may reduce time between esophageal food impaction (EFI) and removal in patients undergoing esophagogastroduodenoscopy (EGD). Am J Gastroenterol. 2017;112:S189.

    Article  Google Scholar 

  27. Gretarsdottir HM, Jonasson JG, Björnsson ES. Etiology and management of esophageal food impaction: a population based study. Scand J Gastroenterol. 2015;50:513–518.

    Article  PubMed  Google Scholar 

  28. Heerasing N, Lee SY, Dowling D, Alexander S. Prevalence of eosinophilic oesophagitis in adults presenting with esophageal food bolus obstruction. J Gastroenterol Hepatol (Australia). 2014;29:57.

    Google Scholar 

  29. Shafique M, Yaqub S, Lie ES, Dahl V, Olsbø F, Røkke O. New and safe treatment of food impacted in the esophagus: a single center experience of 100 consecutive cases. Gastroenterol Res Pract. 2013;2013:142703.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stadler J, Hölscher AH, Feussner H, Dittler J, Siewert JR. The “steakhouse syndrome”. Primary and definitive diagnosis and therapy. Surg Endosc. 1989;3:195–198.

    Article  CAS  PubMed  Google Scholar 

  31. Ikenberry SO, Jue TL, Anderson MA et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73:1085–1091.

    Article  PubMed  Google Scholar 

  32. Birk M, Bauerfeind P, Deprez PH et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48:489–496.

    Article  PubMed  Google Scholar 

  33. Ahmed Z, Arif SF, Ong SL et al. Cap-assisted endoscopic esophageal foreign body removal is safe and efficacious compared to conventional methods. Dig Dis Sci. 2023;68:1411–1425.

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Toledo Medical Center, Toledo, OH, 43614, USA

    Manesh Kumar Gangwani & Zohaib Ahmed

  2. Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA

    Muhammad Aziz & Yaseen Alastal

  3. Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, 48603, USA

    Dushyant Singh Dahiya

  4. Department of Gastroenterology and Hepatology, Augusta University, Augusta, GA, USA

    Abeer Aziz

  5. Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan

    Fnu Priyanka

  6. Department of Medicine, Alleghany General Hospital, Pittsburgh, PA, USA

    Rahul Karna

  7. University of Toledo Libraries, University of Toledo, Toledo, OH, USA

    Wade Lee-Smith

  8. Digestive Health Institute, Thomas Jefferson University, Philadelphia, PA, USA

    Faisal Kamal

  9. Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sumant Inamdar

  10. Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Center Health, Denver, CO, 80210, USA

    Douglas Adler

Authors
  1. Manesh Kumar Gangwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dushyant Singh Dahiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abeer Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fnu Priyanka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rahul Karna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wade Lee-Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zohaib Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Faisal Kamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sumant Inamdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yaseen Alastal
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Douglas Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas Adler.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Research involving human and animal participants

No human subjects/animals were involved in this systematic review and meta-analysis.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 31 KB)

Supplementary file2 (DOCX 16 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gangwani, M.K., Aziz, M., Dahiya, D.S. et al. Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis. Dig Dis Sci 68, 3354–3364 (2023). https://doi.org/10.1007/s10620-023-07988-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-07988-0

Keywords

Search

Navigation