Endoscopic Management of Steakhouse Syndrome

Abstract

Background: Impaction of meat bolus over the lower oesophagus is known as "Steakhouse Syndrome" and is characterized by an abrupt onset of a dysphagia associated with odynophagia, drooling, chest pain, heartburn, neck pain, regurgitation and so on. During last fifty years, various management options like Glucagon, simethicone, carbonated beverages, a cocktail of tartaric acid and bicarbonate, hyoscine butyl bromide, benzodiazepines, opioids etc. have been used. However flexible endoscopy has been advocated to be highly sensitive in diagnosis and management of steakhouse syndrome. Objective: In this study we wanted to evaluate efficacy of endoscopic management of steakhouse syndrome in two endoscopic set ups in Rajshahi city with limited facilities. Methods: Records of 19 patients with steakhouse syndrome were analyzed on retrospective. We used a judicious combination of push and extraction techniques. We used topical oropharyngeal spray anesthesia with conscious sedation like Diazepam or midazolam and hyoscine N-butyl bromide. Resuscitation facilities were available. Result: Most of the patients were male and were in the 50-70 years age group. Almost 90% patients were treated successfully by endoscopic manipulation. Most (68%) of the interventions were carried out between 24 and 72 hours of incidence. Push technique was successful in most (70%) of the cases. Conclusion: Endoscopic manipulation with a differential approach is a reliable and safe procedure for management of steakhouse syndrome. The patients with suspected Steak-house syndrome should be clinically evaluated and referred to a skilled and competent endoscopist at the 
earliest convenience.