Bedside sonography for the diagnosis of esophageal food impaction

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

Research output: Contribution to journalArticle

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)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Sep 13 2016

Keywords

  • Emergency
  • Esophageal foreign body
  • Esophageal ultrasound
  • Impaction

ASJC Scopus subject areas

  • Emergency Medicine

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