I.  Blunt Three-Dimensional Foreign Bodies

A.  Noninvasive Management

• For managing food impactions in the esophagus, noninvasive medical treatments should be tried first to facilitate passage of  the food into the stomach.  This will be successful in the majority of cases, and the need for a more invasive intervention will be rendered unnecessary.

• Carbonated beverages have been used to dislodge impacted food from the esophagus.  Mohammed and Hegeds had patients rapidly drink 100 ml of a carbonated beverage, and impacted meat or other foreign material was expelled propelled from the esophagus into the stomach in 16 of 20 patients (80%) without complications.  Karanjia and Rees treated 8 episodes of food impaction by the administration of Coca-Cola (The Coca-Cola Company, Atlanta, GA) and reported 100% successful removal without complications.  Carbonated beverages have the advantages of being readily available, inexpensive, and free of systemic side effects.
  
  

• Gas-forming mixtures of weak acid and sodium bicarbonate have also been used to dislodge impacted food from the esophagus into the stomach.  Prepackaged effervescent granules, such as E-Z-Gas II (E-Z-EM Co., Inc., Westbury, NY), that are marketed for use in air contrast barium studies of the stomach, may also be used for dislodging soft, blunt impactions.  One packet of E-Z-Gas II, containing citric acid, sodium bicarbonate, and simethicone, is added to 30 ml of water, and the patient is asked to swallow it while in the upright position; this produces at least 400 ml of carbon dioxide gas.  The patient is asked to avoid belching unless chest pressure becomes too uncomfortable.
  
  

• In theory, combination therapy with glucagon, a gas-forming agent, and water should be more effective than use of any single agent.  When using this method, 1.0 mg of glucagon is given IV.  After approximately one minute, the patient is asked to drink one packet of E-Z-Gas II granules in 30 ml of water, followed by one cup (240 ml) of water.  The reported success of combined therapy in relieving food impaction is 75% to 80%.  In practice, this method seems to be less effective than simply having the patient drink a carbonated beverage.