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Is current UK management of oesophageal food bolus obstruction evidence based? An e-mail survey and literature review

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Abstract

There is a great deal of variation in individual management of non-sharp oesophageal food bolus obstruction in the United Kingdom. An e-mail survey of consultants and specialist registrars in ENT was carried out to establish current UK practice. A review of the published literature was under-taken to establish whether current practice is evidence based. The majority of practitioners (95%) do not proceed immediately to rigid oesophagoscopy but use antispasmodic drugs (83%), most commonly hyoscine butylbromide (Buscopan®) and diazepam, to try to induce spontaneous passage of the obstruction. There is currently no evidence in the published literature to support the use of these drugs. The use of Buscopan seems to have been encouraged by a misquoted reference in a prominent ENT textbook. Better evidence is needed to establish the best form of treatment for this relatively common problem.

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Acknowledgments

The authors would like to thank Bridget Cole and John Losasso from the Sir Thomas Browne Library, Norfolk and Norwich University Hospital for their expert help with the literature searches and in obtaining the relevant publications.

Author information

Authors and Affiliations

  1. Norfolk and Norwich University Hospital, Norwich, UK

    T. Price, S. E. M. Jones & P. Q. Montgomery

  2. 2 Grasmere Close, Loughton, Essex, IG10 1SL, UK

    T. Price

Authors
  1. T. Price
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  2. S. E. M. Jones
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  3. P. Q. Montgomery
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Corresponding author

Correspondence to T. Price.

Additional information

Presented at IFOS, Rome, 27 June 2005.

Appendices

Appendix 1: Survey of current management of food bolus obstruction

Hospital trust

Current position

  1. a.

    Does your department have a written protocol for managing these patients? Y/N

  2. b.

    Would you take the patient straight to theatre for rigid endoscopy? Y/N

  3. c.

    Do you routinely administer antispasmodics? Y/N

  4. d.

    If you answered yes to above, which drug/s do you give, by which method of administration and how often do you repeat the dose?

    • A:-

    • B:-

    • C:-

  5. e.

    Do you use any other methods to try and dislodge the bolus (e.g., Gas forming agents, postural, etc.)?

  6. f.

    How long would you wait before deciding to take the patient to theatre?

Thank you for your time!

Thank you for your time!

Thank you for your time!

Appendix 2

The Medline search strategy (1959 to date)

  1. 1.

    SCOPOLAMINE[MH]

  2. 2.

    DIAZEPAM[MH]

  3. 3.

    NITROGLYCERIN[MH]

  4. 4.

    GLUCAGON[MH]

  5. 5.

    Glucagon[tw]

  6. 6.

    GTN[tw]

  7. 7.

    Glyceryl trinitrate[tw]

  8. 8.

    Nitroglycerin[tw]

  9. 9.

    Benzodiazepin*[tw]

  10. 10.

    Diazepam[tw]

  11. 11.

    Buscopan[tw]

  12. 12.

    Hyoscine[tw]

  13. 13.

    Methylscopolamine[tw]

  14. 14.

    Scopolamine[tw]

  15. 15.

    Esophag*[tw]

  16. 16.

    Oesophag*[tw]

  17. 17.

    Aphagia[tw]

  18. 18.

    Dysphagia[tw]

  19. 19.

    ESOPHAGUS[MH]

  20. 20.

    DYSPHAGIA[MH]

  21. 21.

    Food impaction[tw]

  22. 22.

    Food bolus[tw]

  23. 23.

    Foreign body[tw]

  24. 24.

    1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14

  25. 25.

    16 or 17 or 18 or 19 or 20 or 21 or 22 or 23

  26. 26.

    24 and 25 Limits: English, Human.

Appendix 3

The EMBASE Search strategy (1974 to date)

  1. a.

    (ESOPHAGUS-OBSTRUCTION-DT#.DE.)

  2. b.

    (ESOPHAGUS-FOREIGN-BODY-DT#.DE.)

  3. c.

    1 OR 2

  4. d.

    (SCOPOLAMINE-BUTYL-BROMIDE#.DE.)

  5. e.

    DIAZEPAM#.W..DE.

  6. f.

    GLYCERYL-TRINITRATE#.DE.

  7. g.

    NIFEDIPINE#.W..DE.

  8. h.

    ESOPHAGUS-OBSTRUCTION#.DE.

  9. i.

    FOREIGN-BODY#.DE.

  10. j.

    ESOPHAGUS-FOREIGN-BODY#.DE.

  11. k.

    ESOPHAGUS#.W..DE.

  12. l.

    9 and 11

  13. m.

    8 or 10 or 12

13 and (4 or 5 or 6 or 7).

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Price, T., Jones, S.E.M. & Montgomery, P.Q. Is current UK management of oesophageal food bolus obstruction evidence based? An e-mail survey and literature review. Eur Arch Otorhinolaryngol 264, 329–335 (2007). https://doi.org/10.1007/s00405-007-0260-x

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