Glucagon Use for Esophageal Foreign Body Impaction
The Article: “Effectiveness of glucagon in relieving esophageal foreign body impaction: a multicenter study” Ryan P. Bodkin et. al. American Journal of Emergency Medicine. 2016; 34: 1049-1052
Glucagon has been shown to decrease lower esophageal sphincter tone, and therefore has become one of the most widely accepted pharmacological agents for relief of esophageal foreign body impaction despite sparse research on the topic. The purpose of this study was to evaluate the efficacy of glucagon for the resolution of esophageal foreign body impaction (EFBI) at two large academic Emergency Departments.
Retrospective, observational study of patients who received glucagon for EFBI in two academic EDs. (n=127). This was compared to a small control group who did not receive glucagon for EFBI. (n=29)
A total of 127 patients received either IM or IV glucagon at a median dose of 1 mg for relief of EFBI. Of these patients glucagon was successful in the resolution of symptoms in only 18 patients. (14.2%). Endoscopy was required in 92 patients (84.4%) among the glucagon group for definitive treatment of EFBI. When compared to the control group, there was no statistical significance in resolution of symptoms. The most common adverse event among the glucagon group was vomiting which occurred in 16 patients. (12.6%)
This was a relatively small study, incorporating only 127 patient’s in the treatment group and 29 in the control group. This limits the overall power of the study itself. Being a retrospective chart review eliminated the ability to blind the reviewers or the treating physician’s. This also opens those who did the chart review to abstraction bias. Furthermore, an arbitrary time frame of 60 minutes post glucagon administration was chosen as the cutoff for successful resolution of symptoms. Glucagon could be shown to have further efficacy if opened to a longer time frame.
This study further strengthens the argument of the futility of glucagon as a treatment for esophageal foreign body impaction. Glucagon is an expensive drug with a long peak onset of action. This is not ideal for an Emergency Room setting. That being said it is a relatively safe medication, and if it helps expedite definitive care from your GI colleagues than it may be worth it to try. Remember the patient must have a patent airway and be oriented at the time of glucagon administration to reduce aspiration risk.