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In adults, esophageal foreign body impactions most commonly are caused by inadequately chewed pieces of meat. Most of these foreign bodies pass spontaneously into the stomach, but 10–20% require some form of therapeutic intervention [140]. The risk of perforation is less than 1% during the first 24 h, but this risk increases substantially after 24 h because of ischemia and pressure necrosis at the site of impaction [140]. Affected individuals typically present with acute onset of dysphagia and substernal chest pain.

Figure 6.78 Esophageal food impaction. (A) On the initial barium study, an impacted bolus of meat in the distal esophagus appears as a polypoid defect (arrows) with complete obstruction at this level. (B) A repeat study 10 days after endoscopic removal of the bolus reveals a lower esophageal ring (arrow) as the cause of the impaction.

In the past, barium studies were often performed on patients with suspected esophageal food impaction, and if an impaction was present, the fluoroscopist sometimes attempted to relieve the impaction by administration of an oral effervescent agent, intravenous glucagon, or both. Because endoscopy is a more effective technique for relieving esophageal food impactions, and because residual barium above an impaction can impede endoscopic visualization or retrieval of the impacted food bolus, endoscopy has become the diagnostic and therapeutic test of choice for these patients [141].

Nevertheless, contrast studies are occasionally performed in patients with suspected food impaction to confirm the presence of obstruction, determine its level, and rule out esophageal perforation. An impacted food bolus typically appears as a polypoid defect with an irregular meniscus superiorly [140] (Figure 6.78A). Because of the degree of obstruction, it may be difficult to assess the underlying esophagus at the time of impaction. It is therefore prudent to perform a follow‐up barium study after the impaction has been relieved to determine whether the impaction was caused by a pathologic area of narrowing (Figure 6.78B). The most common causes are Schatzki rings and peptic strictures [140].