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Food bolus obstruction

Most born with OA will experience episodes of food bolus obstruction, whether this is with every solid food item ingested or infrequently. However, the vast majority have developed a wide range of techniques to mitigate this problem. This ranges from drinking copious fluids with each meal, avoiding certain foods and textures, and using particular postures to encourage difficult items to move in the oesophagus. Even when prolonged obstruction occurs, many will use tried and trusted methods such as carbonated drinks and fruit juices to dissolve the obstruction. Nonetheless, on occasion, this obstruction will need medical attention.


Patients presenting with food bolus obstruction usually have oesophageal pathology causing the impaction. (40) Those born with OA/TOF are at high risk of food bolus obstruction compared to the general population due to a number of factors. These include oesophageal dysmotility, prior oesophageal surgery scarring, eosinophilic oesophagitis and new stricture formations.


There is usually a history of acute dysphagia after consumption of a food bolus, which may be severe enough to prevent swallowing saliva, resulting in drooling. Chest pain, neck pain, odynophagia may also be present. Aspiration may occur, as may perforation of the oesophagus if obstruction is prolonged.


Patients can usually identify the bolus ingestion and onset of symptoms and may be able to localise discomfort. However, even in a normally innervated oesophagus this correlates poorly with the site of obstruction, and this is even more true in adults born with OA, as the repaired oesophagus or interposition may be insensate in some areas. (40,41)

Investigation and treatment

In uncomplicated food bolus obstruction, endoscopy and biopsies is the investigation/treatment of choice without need for radiology. These patients need to be managed in a hospital setting, usually Accident and Emergency, or on-call gastroenterology admission.

  • Watch and wait. In a stable patient able to manage secretions, urgent endoscopy may not be necessary; however, an obstruction lasting more than 24 hours makes retrieval more difficult.
  • Adult guidelines recommend rapid endoscopy for the removal of oesophageal obstruction within two or, at the latest, six hours when there is complete obstruction (unable to swallow saliva), and urgent within 24 hours when there is partial oesophageal obstruction. (210,211)
  • Endoscopic intervention is urgent in those who can’t swallow their own secretions due to risk of aspiration and respiratory compromise due to pressure of the bolus on floppy airways. This is usually retrieval using nets, baskets or forceps, though pushing is used in some instances but can increase the risk of perforation. (40,41) Endoscopic dilatation may sometimes be appropriate at the same time as retrieval of the food bolus.