Jamal Kriem, Riad Rahhal

Adult-based guidelines support the use of the pull (extraction) endoscopic technique in managing esophageal food bolus impactions (FBIs) but allow the consideration of the push (advancement) technique with caution based on available published literature. The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines mention the use of gentle endoscopic pushing for disimpaction but elaborate that this technique has not been studied in children. Our study aimed at assessing the safety and efficacy of the push technique in managing pediatric esophageal FBIs. This was a retrospective cohort study of all pediatric patients presenting with esophageal FBIs to a pediatric tertiary care center from 2003 to 2016. Two hundred and forty two procedures for esophageal foreign body removal were reviewed. Thirty nine procedures for managing esophageal FBIs were included in a total of 23 patients (1-4 procedures per patient). The most common underlying diagnoses were eosinophilic esophagitis and repaired tracheoesophageal fistula. The cohort had a median age of 8 years and median weight of 34.4 kg. Initial endoscopic disimpaction methods included 20 push and 19 pull technique attempts with success rates of 65% and 68% respectively (p = 1.0). Unsuccessful attempts using one technique were successfully accomplished using the other technique. Patients initially managed by either of the two disimpaction techniques did not differ in age, weight, gender or underlying diagnoses. No procedure related complications were reported at our center. This study shows that the push technique is as safe and effective as the pull technique in managing esophageal FBIs in pediatric patients.