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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]

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.

Search Strategy

Medline 1966- to February Week 2 2007 Embase 1980 to 2007 Week 08 using the OVID interface
The Cochrane Library Issue 1 2007
[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
Cochrane: buscopan (ti, ab.kw.) 48 records - none relevant

Search Outcome

25 unique papers were found employing the stated search strategy, only 2 of which were relevant to the question posed.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Thomas 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
Basavaraj 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

Comment(s)

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

References

1. Thomas L, Webb C, Duvv S et al. Is buscopan effective in meat bolus obstruction? Clin Otolaryngol 2005;30:183-5.
2. Basavaraj S, Penumetcha KR, Cable HR et al. Buscopan in oesophageal food bolus: is it really effective? Eur Arch Otorhinolaryngol 2005;262:524-7.