This page discusses the proper way to perform an esophageal food disimpaction. The original paper that informs this page is discussed more here.
HOW IS THIS TECHNIQUE PROPERLY PERFORMED?
Below is a general overview highlighting the major points of how to conduct this technique:
- Conduct the initial esophogram using a small volume of water soluble, iso-osmolar contrast: in many cases, 5 ml of contrast is enough to diagnose the impaction (and this low volume decreases the risk of aspiration in the case of very proximal obstruction). A water soluble contrast is also recommended to be used because in the case of esophageal perforation it will not cause as many complications if leaked into the mediastinum/peritoneum. Furthermore, a contrast agent that is iso-osmolar to serum (such as omnipaque 180) should be used because IF it is aspirated in the lungs it will not cause pulmonary edema (compared to other hyperosmolar solutions). This is done in the upright position.
- Transition the patient into the supine position, and administer glucagon. 1 mg of glucagon is given IV over 30 seconds (this infusion rate produces less vomiting).
- Patient is immediately turned upright again and is kept there for 2 minutes: this is so the glucagon can begin to work on relaxing the esophageal sphincter/smooth muscle. It needs time to act on the body.
- Patient is given one pack of E-Z Gas II and a cup of water. the E-Z Gas II is dissolved in 30 mls of water and given to the patient, followed by 240 mls of water.
- If the patient feels relief, a second esohpagram is obtained: about 50 mls of the same contrast used initially is used to confirm that the foreign body has passed.
Page Updated: 08.06.2017