1. Food Bolus Management: 2 Centers Experience Aaron Ferguson Mohd Afiq Mohd Slim Philip Bell Ramzan Ullah

2. Standard of Care United Kingdom  None United States of America Management of ingested foreign bodies and food impactions. 2011. American Society for Gastrointestinal Endoscopy

3. Aim To analyse the current practice from 2 different ENT centers To determine potential ways of managing this condition in a more efficient and effective manner.

4. Method Retrospective data collection Long term impact  Site A, 3 years evaluation, point of evaluation occur from A&E Short term impact  Site B (RVH), 6 months evaluation, point of evaluation occur when admitted into the department Cost analysis Two tailed student t-test

5. Demographic Data A&E Incidence in 3 years 176 presentations 78.8% discharged 21.2% admission Average Length of Stay Conservative = 2.1 days Rigid Oesophagoscopy = 2.9 days

6. Trending Data Gender M>F 13:1 Younger age 47 vs 56

7. Type of Food Bolus Management

8. It is all about the money

9. So how much will it cost actually? Conservative  1050.44 Rigid Oesophagoscopy+In-patient  2311.90 Short Stay Unit/Day Case Model+Flex Oesophagoscopy 4 hour  725 8 hour  825 12 hour  925

10. Is it a huge different? Conservative vs Day Case Conservative vs Rigid Rigid vs Day Case 1 Junior Doctor3 Junior Doctor or 1 Consultant Per YEAR 4 Junior Doctor or 2 Junior Consultants Per YEAR

11. What we proposed Food Bolus Oesophageal Impaction Signs of Airway ObstructionNo Airway Obstruction Rigid Oesophagoscopy ± Rigid Bronchoscopy AP and Lateral Neck X-ray AP Chest X-ray Flexible Nasolaryngoscopy for direct supraglotic visualization Short Stay Unit Admission With Flexible Oesophagoscopy In doubt of Airway Integrity Safe Airway Unsafe Airway Failure of removal

12. Challenges Should we even admit them under us if no airway compromise for food bolus? Cost of Rigid Oesophagoscopy? Theatre slot? CEPOD? Technical limitation? Cost of Flexible Oesophagoscopy? Gastro vs General Surgeon Day Procedure and CEPOD list ENT role? Future training scope (technical flexibility) Transnasal vs Oral? (technical limitation)