Buscopan for oesophageal food bolus impaction

Buscopan for oesophageal food bolus impaction

Report by R Anderson, Senior House Officer

Search checked by Jason Lee, Specialist Registrar

Leeds General Infirmary

A short cut review was carried out to establish whether buscopan is effective at inducing early resolution and minimising the need for surgery in patients with oesophageal food bolus impaction. Twenty‐five papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that there is no good evidence that buscopan is effective. A properly powered RCT is needed.

Clinical scenario

A 21‐year‐old male attends the emergency department with “something stuck” after eating a donner kebab. You diagnose oesophageal food bolus impaction. You have heard that there are a number of non‐operative early options in management and wonder if one of them, the anti‐spasmodic, buscopan, would be an effective treatment.

Three‐part question

In [a patient with oesophageal food bolus impaction] is [buscopan] effective at [inducing early resolution and minimising the need for operative intervention]?

Search strategy

The Cochrane Library Issue 1 2007 buscopan (ti, ab.kw.) 48 records—none relevant. Medline 1966‐ to February Week 2 2007 Embase 1980 to 2007 Week 08 using the OVID interface [buscopan.mp. OR exp Butylscopolammonium Bromide/] AND [oesophag$.mp. OR esophag$.mp. OR exp Esophagus/] AND [exp Foreign Bodies/OR bolus$.mp. OR impact$.mp. OR obstruct$.mp. OR dysphagia.mp. OR foreign bod$.mp. OR meat.mp.] Limit to English language and Human.

Outcome

Twenty‐five unique papers were found employing the stated search strategy, only two of which were relevant to the question posed. There are shown in table 2.

Table 2.

Author, country, date	Patient group	Study type	Outcomes	Key results	Study weaknesses
Basavaraj S et al, 2005, UK	43 patients with food bolus obstruction treated over a 6 year period 35 treated with buscopan, 8 without	Retrospective survey	Spontaneous dislodgement	68% vs 62.5% (P = 0.37)	Retrospective
					Not randomised
					Small numbers
Thomas L et al, 2005, UK	29 patients (31 episodes) presenting to an Emergency Department over 16 years with meat bolus obstruction 22 episodes treated with buscopan, 9 without	Retrospective survey	Spontaneous dislodgement	82% vs 78% (P = 0.577)	Retrospective
					Not randomised
					Small numbers

Comments

The two studies shown show there is no difference in the spontaneous dislodgement rate in patients who receive buscopan when compared to those who do not. However the studies are both retrospective, non‐randomised and small. A power calculation performed by the authors of the second study based on their data indicates that a randomised trial would require 140 patients in each arm to detect a 10% difference at p<0.05 at a power of 85%.

Clinical bottom line

There is no direct evidence to support the effectiveness of buscopan at resolving food bolus impaction in the oesophagus. A large RCT is needed