Available online 2 August 2022

Abstract

Total esophageal food impaction is extremely rare. We report a patient with Parkinsonism who presented with total dysphagia to solids and liquids and with inability to swallow her saliva of 3 days duration. She did not present sooner as she was afraid of contracting COVID-19 during hospitalization. Chest CT scan revealed total esophageal food impaction. Awake fiberoptic endotracheal intubation followed by EGD and clearance of the impacted food were performed. This patient illustrates esophageal involvement in Parkinson’s disease, delayed presentation with an emergency in the COVID-19 era, and the multidisciplinary approach to minimize the risk of aspiration during endoscopy.

Introduction

Esophageal food impaction is a common problem with an estimated annual incidence rate of 13 per 100,000 person-years. Multiple esophageal disorders have been strongly associated with food impaction. These include structural esophageal diseases such as Schatzki rings, peptic strictures, esophageal rings, cancer; and functional esophageal abnormalities such as achalasia and spastic dysmotility (1). Additionally, eosinophilic esophagitis is being increasingly recognized as a major cause of esophageal food impaction especially in the younger population (2). Regardless of the etiology, esophageal food impaction is considered a GI emergency that requires immediate medical care. It has been reported that around 25% of patients with food impaction have spontaneous resolution of symptoms while the rest will require intervention with medications, endoscopy, or far less commonly surgery (3). Endoscopy should be done within 6-24 hours, depending on whether the obstruction is partial or complete, in order to decrease the risk of complications such as perforation, obstruction and fistula formation, and to increase the probability of successful disimpaction (4). The endoscopic intervention itself also carries its own set of complications including mucosal lacerations, bleeding, and aspiration pneumonia (5).

Although esophageal food bolus impaction is common, there are no reports on total esophageal food impaction or on its optimal management.

Section snippetsCase Report

A 79-year-old woman presented to our hospital with new onset dysphagia to solids and liquids, inability to tolerate any food intake or to swallow her saliva of 3 days duration. Prior to this episode, the patient denied having had any episodes of choking, dysphagia, or heartburn. The patient was known to have long standing Parkinson’s disease, diabetes, hypertension, and hypothyroidism. Her list of medications included carbidopa-levodopa, metformin, amlodipine, and levothyroxine. The patient did

Discussion

Esophageal food impaction is a GI emergency that requires endoscopic intervention on an emergent or urgent basis depending on the degree of obstruction (4). In a recent review, Cha et al. looked at the safety of different sedation methods, namely conscious sedation, monitored anesthesia care, and general anesthesia (GA) in emergent endoscopic interventions. They found no difference in adverse event rates following endoscopic removal of foreign bodies. However, they classified impactions based

Uncited references

[1], [2], [3], [4], [5], [6].

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (6)S.O. Ikenberry et al.Management of ingested foreign bodies and food impactions

Gastrointestinal endoscopy

(2011)

J. Melendez-Rosado et al.Esophageal Food Impaction

Journal of clinical gastroenterology

(2019)

P. Navarro et al.Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies

Alimentary pharmacology & therapeutics

(2019)

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© 2022 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.