Bedside sonography for the diagnosis of esophageal food impaction

Jennifer Singleton, Jesse M. Schafer, Jeremiah S. Hinson, Erin M. Kane, Sherieka Wright, Beatrice Hoffmann

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied. Objective To evaluate the role of EUS in detection of EFB and to characterize sonographic findings. Methods A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB. Results: All patients with suspected EFB had esophageal dilatation (17.5 mm vs 9.3 mm in healthy controls; p = 0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD. Conclusion In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.

Original languageEnglish (US)
Pages (from-to)720-724
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume35
Issue number5
DOIs
StatePublished - May 2017

Keywords

  • Emergency
  • Esophageal foreign body
  • Esophageal ultrasound
  • Impaction

ASJC Scopus subject areas

  • Emergency Medicine

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