Esophageal impaction can result in airway obstruction, stricture, or perforation. The perforation can be due to multiple mechanisms but is generally either mechanical (ingested bones) or via chemical corrosion (button battery). The most common sites of obstruction are the:
- Cricopharyngeus (near C6) muscle is the most common (about 75%)
- Aortic cross over the esophagus
- Lower Esophageal Sphincter
Although uncomplicated food impactions (no bones, incomplete obstruction) can be managed expectantly, it should not be allowed to remain for > 24hrs. Endoscopy is the only difinitive method to ensure removal but carbonated beverages and glucagon can be considered. Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy. The major side effect of glucagon is vomiting and can increase the risk for esophageal perforation or aspiration
