Effectiveness of cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus

Abstract

BACKGROUND AND AIM: The use of a transparent cap has been found to be effective in retrieval of esophageal foreign body. However, data on the use of a cap in food bolus obstruction (FBO) are limited. This study aims to assess the effectiveness of a cap-assisted technique compared with conventional techniques in removal of FBO. METHODS: All patients who underwent an endoscopy for boneless FBO between 2011-2016 were prospectively recruited. The measured outcomes were procedure time, success rate of food bolus (FB) extraction, rate of en bloc removal, procedure-related adverse events and length of hospital stay (LOS) between the 2 groups. RESULTS: Of the 315 patients who had an endoscopy for FBO, 48 (15.2%) had spontaneous passage of FB and 267 (84.8%) had impacted FB. 68 (25%) patients had the “push” maneuver and 199 (75%) patients had the “pull” maneuver to remove FB. Of those who had the “pull” maneuver, 93 used a cap and 106 used conventional device(s). The use of a cap was associated with a shorter procedural time (34.3 ± 8.0 minutes versus 43.3 ± 22.6 minutes, P=0.003), a higher rate of en bloc removal (87.3% versus 22.8%, P<0.001), a lower rate of adverse events (0/93 versus 7/106, P=0.01) and a shorter LOS (1.0 ± 0.6 days versus 1.6 ± 1.4 days (P=0.0017). CONCLUSION: Cap-assisted technique has been found to be effective and safe in removal of esophageal FBO. This technique was associated with a shorter procedural time and a reduced LOS compared with conventional techniques. However, these findings require further validation in a randomized control study.