An endoscopic strategy for oesophageal food bolus impactions: a multicentre retrospective study of 750 patients over a decade

Background The management of oesophageal food bolus impactions (OFBIs) has seen a growing preference for the use of distal attachment caps over traditional devices such as nets, snares and grasping forceps. Aim Our aim was to evaluate the outcomes of procedural efficiency and cost implications of different endoscopic strategies. Methods This was a retrospective multicentre review of all adults with soft OFBIs between 2011 and 2021. Data were collected using patient medical records, with 750 patients meeting the inclusion criteria. Results The mean age was 56 years, with a predominance of males (72.3%). Eosinophilic esophagitis (EoE) was the primary cause of OFBI from 2019 onwards, replacing reflux esophagitis. Medical management was attempted in 75.2% of patients. The ‘push’ technique showed significantly shorter procedure durations compared to ‘pull’ strategies (25.2 ± 19.6 vs 37.0 ± 24.7 min; P < 0.001). Cap‐based pull strategies resulted in shorter procedure times (30.7 ± 16.0 vs 40.2 ± 28.0 min; P = 0.002), higher en‐bloc removal rates (80.4% vs 19.8%; P < 0.001) and fewer instruments used (1.0 vs 1.5; P < 0.001) compared to conventional strategies without a difference in adverse events. Multivariable regression confirmed cap‐assisted techniques, push strategy, and sedation (vs intubation) were independently associated with significantly shorter intervention times. Cost modelling estimated a per‐case saving of $439.98 with cap use. Conclusion Cap‐assisted endoscopy offers superior clinical efficacy and cost‐effectiveness compared to conventional methods. These findings support the routine use of cap‐assisted techniques and suggest that a push‐based strategy could be considered as the initial approach in the endoscopic management of food bolus impactions.