Introduction: Endoscopy is the main tool for the management of esophageal food impaction and bezoars. We describe a case where endoscopy was unsuccessful, and success was achieved with a cocktail of Creon and Coca-Cola.
Case Description/Methods: 82-year-old man with no comorbidities presented with shortness of breath and dizziness. In the emergency room, he was found to have stridor and progressive respiratory distress requiring endotracheal intubation for airway protection. Direct laryngoscopic examination was normal. A CT PE study ruled out pulmonary embolism, findings suggestive of lower lobes pneumonia as well as a distended esophagus compressing the trachea, and possible esophageal food impaction were seen.
Endoscopy revealed a severely dilated esophagus with a large amount of food in the entire esophagus and a phytobezoar in the lower esophagus. An esophageal overtube was deployed and repeated attempts to remove the food and bezoar with a wide range of instruments such as raptor forceps, Roth net, and talon grasping forceps, failed. Attempts to push it into the stomach were unsuccessful. Due to the size of the bezoar and prolonged duration, the procedure was aborted. Surgical removal was deferred given the patient’s advanced age and its associated mortality and morbidity. A bronchoscopy examination showed left lower lobe secretions and possible food aspiration.
A nasogastric tube was placed into the esophagus and a cocktail of 3 capsules of creon dissolved in 165 mL of Coca-Cola was administered thrice a day over period of 4 days. A repeat endoscopy on day 5 showed a diffusely dilated esophagus with distal esophagitis. There was no evidence of food or bezoar in the esophagus, stomach, and proximal duodenum. Patient was liberated from mechanical ventilation on day 6 and a high-resolution esophageal manometry on day 8 revealed type 1 achalasia.
Discussion: Endoscopy remains the mainstay for the diagnosis and treatment of esophageal food impaction and bezoars. Other treatment options like surgical intervention are associated with high morbidity and mortality. Case reports have described the use of Coca-Cola and the addition of Creon in the treatment of esophageal food impactions and bezoars. In our experience, this method appears to be a safe, effective and inexpensive treatment, and should be considered an alternative therapy when endoscopy is unsuccessful prior to more aggressive interventions.
Figure: A) Coronal section of chest CT showing distended esophagus with impacted food bolus (yellow arrow) B and C) Initial upper endoscopy with food bolus and bezoar impaction in the proximal and distal esophagus respectively D and E) Repeat endoscopy showing clearance of food bolus and bezoar post cocktail of creon and coca cola
Disclosures:
Nikhitha Mantri indicated no relevant financial relationships.
Haozhe Sun indicated no relevant financial relationships.
Kinnera Sahithi Urlapu indicated no relevant financial relationships.
Priscilla Lajara Hallal indicated no relevant financial relationships.
Ahmed Alemam indicated no relevant financial relationships.
Harish Patel indicated no relevant financial relationships.
Jasbir Makker indicated no relevant financial relationships.
Gilda Diaz-Fuentes indicated no relevant financial relationships.
Myrta Daniel indicated no relevant financial relationships.
Sridhar Chilimuri indicated no relevant financial relationships.
Nikhitha Mantri, MD1, Haozhe Sun, MD2, Kinnera Sahithi Urlapu, MBBS2, Priscilla Lajara Hallal, MD3, Ahmed Alemam, MD2, Harish Patel, FACG4, Jasbir Makker, MD, FACG2, Gilda Diaz-Fuentes, MD2, Myrta Daniel, 5, Sridhar Chilimuri, MD2. P0518 - Coca-Cola and Creon Therapy for Esophageal Food Bolus Impaction and Bezoar, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
