Esophageal Food Impaction: Causes, Elective Intubation, and Associated Adverse Events.

GOALS: The goal of this study is to examine the causes, type of adverse events (AE), and effects of elective intubation in outcomes associated with esophageal food impaction (EFI). BACKGROUND: EFI is a gastrointestinal emergency requiring immediate medical attention. STUDY: Retrospective review of all EFI cases presenting at 3 large tertiary centers from October 1, 2011 to October 31, 2014 and all cases registered in the Clinical Outcome Research Initiative (CORI) database from January 1, 2000 to December 31, 2012. Statistical analysis compared health care utilization, AEs, and outcomes in patients with or without elective intubation. RESULTS: A total of 214 cases presenting with EFI at our 3 referral hospitals and 4950 cases in the CORI database met inclusion criteria. Prevalence of structural disorders was similar in the Mayo Clinic and CORI datasets: 24.3% and 27.7% had strictures, and 3.8% and 2.5% had a tumor, respectively. AEs in the nonintubation group were 14.7% compared with 33.3% in the elective intubation group (P=0.003); however, 71.0% of these events were associated with EFI itself and not therapeutic procedure. Esophageal AEs were common (15.0%), followed by pulmonary and cardiovascular events with 3.0% and 1.4%, respectively. Severity of the AEs was influenced by the impaction-to-endoscopy time. CONCLUSIONS: Prevalence of structural esophageal disorders was similar to previous smaller studies. Elective intubation was associated with increased AEs; however, this is felt to be because of the nature of EFI itself and not by therapeutic endoscopy. Prolonged impaction-to-endoscopy time was associated with severe AEs.

Erratum: Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study.

[This corrects the article DOI: 10.1055/s-0034-1390789.].

Diminutive colorectal polyp resection comparing hot and cold snare and cold biopsy forceps polypectomy. Results of a pilot randomized, single-center study (with videos).

BACKGROUND: The optimal method of diminutive polypectomy (< 6 mm) is unknown. OBJECTIVE: To assess the rates of incomplete resection of diminutive polyps of the colon using three standard polyp resection techniques (hot snare, cold snare, and cold biopsy forceps). DESIGN: Randomized, pilot study. SETTINGS: Single-center endoscopy center. PATIENTS: PATIENTS undergoing routine outpatient colonoscopies. INTERVENTIONS: Polypectomy was performed using the method to which the patient was randomized. Following retrieval of the polyp, the polypectomy base was lifted by submucosal injection of normal saline and then excised using the cold snare device. If no tissue could be removed, then at least four cold biopsies using forceps of the remaining margin were obtained. MAIN OUTCOME MEASURES: Adequacy of resection of diminutive polyps, which was defined as no visible adenoma or hyperplastic tissue seen in the base tissue on histology. RESULTS: A total of 60 patients were enrolled (57 % male), the mean age was 60 (range 33 - 82), and 62 polyps were randomized from 37 patients. The mean polyp size was 3.6 mm (range 2 - 5 mm) and 37 polyps (60 %) were adenomatous. Overall incomplete polyp resection rate was 9 % (95 %CI 3 - 19 %), 5 of 37 (14 %) for adenomas. By the study arm, the incomplete resection rates were 1 of 18 (6 %) for hot snare, 2 of 21 (10 %) for cold snare, and 2 of 18 (11 %) for cold biopsy forceps. The majority of polyp bases were removed with cold biopsy forceps since most of the endoscopists did not feel that the saline lift cold snare method was feasible or appropriate. LIMITATIONS: Small sample size; endoscopic mucosal resection (EMR) of the polyp base tissue was not routinely performed. CONCLUSIONS: Recruiting patients to a pilot study that randomized polyps to one of three common methods of polypectomy for diminutive polyps was feasible, and approximately 1 in 10 diminutive polyps found on colonoscopy were incompletely resected by standard polypectomy methods.