Intravenous glucagon in the management of esophageal food obstruction

The use of intravenous glucagon in patients with obstructing esophageal food impaction of at least 24-hours duration has recently been described. Two cases of acute esophageal obstruction were relieved within ten minutes by intravenous infusion of 1 mg of glucagon. Esophagram performed both before and after glucagon administration confirmed the original obstruction and the passage of the food bolus. Therapy for bolus obstruction of the esophagus has classically included proteolytic enzyme digestion, as well as esophagoscopy with manual extraction. Each entails risk of esophageal perforation and mediastinitis. Also, the dose of proteolytic enzymes, such as papain, may take several hours to administer while endoscopic examination is generally not feasible as an outpatient emergency procedure. Intravenous glucagon can dissolve food other than meat and has the further advantage of safety in the patient in which anticholinergics, another occasionally employed therapy, are contraindicated. A protocol for management of these patients is included.