Does Earlier Endoscopy Improve Outcomes in Oesophageal Food Bolus Impaction?: Gut | July 2026

Introduction:

European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommend emergent endoscopy within 6 hours for complete oesophageal food bolus obstruction and urgent endoscopy within 24 hours for incomplete obstruction. However, these recommendations are largely based on studies involving mixed foreign body ingestions rather than isolated food bolus impactions. This multicentre study evaluated whether delayed endoscopy increases the risk of oesophageal perforation or aspiration pneumonia in patients presenting with oesophageal food bolus impaction.

Why was this study needed?

Current guideline recommendations are based on limited evidence specific to food bolus impaction.

Most previous studies included mixed foreign bodies, particularly sharp objects, which carry a different risk profile.

The relationship between timing of endoscopy and complications in soft food bolus impaction remains uncertain.

Better evidence is needed to develop practical, risk-stratified timing pathways for emergency endoscopy.

Avoiding unnecessary overnight emergency procedures could improve healthcare resource utilization without compromising patient safety.

Results:

A total of 72 patients with suspected oesophageal food bolus impaction were included across three centres.

Only 2.8% of patients underwent endoscopy within the guideline-recommended 6-hour window, while the median time to endoscopy was approximately 20 hours.

No oesophageal perforations occurred in the entire study cohort.

Aspiration pneumonia was uncommon, occurring in only two patients, both of whom underwent endoscopy more than 24 hours after presentation.

Increasing time to endoscopy was not significantly associated with the risk of aspiration pneumonia.

The majority of impactions involved soft food boluses, suggesting a lower complication risk than other oesophageal foreign bodies.

Clinical Impact:

This study suggests that, in patients with soft oesophageal food bolus impaction, modest delays to endoscopy may not substantially increase the risk of perforation or aspiration pneumonia. While current guideline recommendations should remain unchanged, the findings question whether all patients require immediate overnight intervention. Larger prospective studies are needed to identify patients who truly benefit from emergent endoscopy and to develop individualised, risk-based management pathways.

Bottom Line:

In this multicentre cohort, delayed endoscopy for soft oesophageal food bolus impaction was not associated with an increased risk of perforation or aspiration pneumonia. Although current guidelines continue to recommend early intervention, these findings support further prospective studies to determine whether selected low-risk patients can be managed safely with a more flexible timing strategy.