I provide online consent and agree to participate in this survey voluntarily
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Yes
No
Are you a board certified specialist in gastroenterology?
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Yes
No
Do you perform upper endoscopy including food disimpaction primarily in
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adults
children
In a typical month in which you are practicing, approximately how many esophageal food impactions (EFI) do you treat?
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0 esophageal food impaction
1-5 esophageal food impactions
6-10 esophageal food impactions
> 10 esophageal food impactions
How long (in minutes) is reasonable before taking any action?
Taking medication, please specify
Other action to be taken, please specify
After what time frame should a patient without known EoE seek medical help if the esophageal food impaction has not resolved spontaneously (or with the above mentioned recommendations)?
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within 10 minutes
11-30 minutes
31-59 minutes
1-2 h
> 2h
After what time frame should a patient with known EoE seek medical help if the esophageal food impaction has not resolved spontaneously (or with the above mentioned recommendations)?
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within 10 minutes
11-30 minutes
31-59 minutes
1-2 h
> 2h
Which Specialist should be called initially by the "Doctor on Duty at the ER" for a patient with suspected EFI?
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ENT
Gastroenterologist
Other, please specify
Other physician, please specify
In general, in a patient with a suspected food impaction when would you obtain blood analysis during initial evaluation?
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Please specify which age you would define as cut-off?
Please specify which comorbidities
Other reason to obtain blood analysis, please specify
In general, in a patient with a suspected food impaction when would you obtain a gastrographin/water soluble contrast study?
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Please specify which age you would define as cut-off
Please specify which comorbidities
Other reason to obtain gastrographin contrast study?
In general, in a patient with a suspected food impaction when would you obtain a CT-scan study?
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Please specify which age you would define as cut-off?
Please specify which comorbidities
Other reason to obtain CT-scan, please specify
In general, in a patient with a suspected food impaction when would you obtain a ECG?
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Please specify which age you would define as cut-off?
Please specify which comorbidities
Other reason to obtain ECG, please specify
In general, when would you obtain a plain chest xray in a patient with suspected food impaction?
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Please specify which age you would define as cut-off?
Please specify which comorbidities?
Other reason to obtain a plain chest xray, please specify
Other medication, please specify
Other measure, please specify
Should the "GI on Duty" always perform an endoscopy when being called to a patient with suspected EFI?
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Yes, an endoscopy should in general always be performed
No, in case of a not empty stomach an endoscopy should be postponed
No, in case of comorbidities, the endoscopy should no be performed
No, other reason to not perform the endoscopy. Please specify.
Other reason not to perform the endoscopy, please specify.
When should the "GI on Duty" perform the endoscopy during regular business hours?
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As soon as possible
Wait until the stomach is empty, about 6 hours after the last meal.
Within the first 6 hours of the food impaction
Within the first 12 hours of the food impaction
Within the first 24 hours of the food impaction
Endoscopy can wait 24 hours after the food impaction
When should the "GI on Duty" perform the endoscopy outside business hours (e.g. after hours)?
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As soon as possible
Wait until the stomach is empty, about 6 hours after the last meal.
Within the first 6 hours of the food impaction
Within the first 12 hours of the food impaction
Within the first 24 hours of the food impaction
Endoscopy can wait 24 hours after the food impaction
Next working day (which can be after weekend)
In general, what type of sedation would you recommend for endoscopy of a suspected EFI in a patient without comorbidities?
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Conscious sedation with disoprivan without an anesthesiologist
Conscious sedation with midazolam without an anesthesiologist
Conscious sedation with midazolam with fentanyl without an anesthesiologist
other medication, please specify
Monitored anesthesia care (anesthesiologist responsible of medication)
No sedation recommended
Please specify other medication
Should endotracheal intubation (by an anesthesiologist or anesthesia provider) be performed in the setting of endoscopy for suspected EFI?
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Other reasons to perform an intubation, please specify
Do you recommend routine use of an overtube for endoscopic management of esophageal food impactions?
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No, normally not
Yes, but only in intubated patients
Yes, in all patients
Do you recommend that esophageal biopsies be performed during an emergency endoscopy for EFI in a patient without having a diagnosis of EoE?
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How many biopsies of the esophagus should be taken during emergency endoscopy?
1-2 in at least one location
3-4 in at least one location
1-2 in at least two locations
3-4 in at least two locations
5-6 in at least to locations
7-8 in at least two locations
Do you recommend that esophageal biopsies be performed during an emergency endoscopy for EFI in a patient with an established diagnosis of EoE?
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How many biopsies of the esophagus should be taken during emergency endoscopy?
1-2 in at least one location
3-4 in at least one location
1-2 in at least two locations
3-4 in at least two locations
5-6 in at least to locations
7-8 in at least two locations
Would you recommend that the endoscopist performs a dilation during an emergency endoscopy for a bolus removal in a patient with suspected (but not established) EoE?
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Yes, generally always (also if no obvious stricture is present)
Yes, but only if an obvious stricture is present and there are no signs of inflammation or esophageal injury from the impaction
Yes, but only if an obvious stricture is present regardless of inflammation
No, never
Should the endoscopist perform a dilation during an emergency endoscopy for a bolus removal in a patient with established EoE?
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Yes, always (also if no obvious stricture is present)
Yes, but only if an obvious stricture is present and there are no signs of inflammation or esophageal injury from the impaction
Yes, but only if an obvious stricture is present regardless of inflammation
No
Upon entering the esophagus with a food bolus do you think attempting to push the food bolus into the stomach is feasible?
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Pushing gently the bolus down to the stomach should always be tried
Sometimes
Never. You should not push the bolus blindly
If attempting to push food into the stomach, which technique do you think is the best?
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gentle slide by on either side of bolus
pushing directly in middle of bolus
combination
Which of the following devices for pushing or for extraction of an impacted bolus do you use?
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When would you recommend a routine patient be discharged after successful removal of an impacted food bolus?
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As soon as he/she has gained consciousness and tolerating some oral intake - ie routine care after an endoscopy
After a perforation or aspiration is excluded by X-ray or CT-scan
After an uneventful 24-h hospital stay
If esophageal biopsies are obtained for suspected EoE at the time of endoscopy for an acute food impaction, should a treatment be started/prescribed immediately?
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Yes, with other medicines such as____, please specify
If esophageal biopsies were NOT obtained at the time of endoscopy for an acute food impaction, should a treatment be started/prescribed immediately?
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Yes, with other medicines, such as ____, please specify
Imagine a patient who had a recent food impaction with typical endoscopic findings for an EoE (Edema, Rings, Exsudates, Furrows and/or Strictures). No esophageal biopsies were performed at the time of the impaction and he/she was immediately started on PPI afterwards. What would you recommend for the timing of his next endoscopy?
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Repeat endoscopy as soon as possible (on PPI)
Stop PPI and repeat endoscopy in 2-4 weeks
Stop PPI and repeat endoscopy in 5-8 weeks
Stop PPI and repeat endoscopy in > 8 weeks
Stop PPI and no surveillance endoscopy needed
Continue PPI and repeat endoscopy in 2-4 weeks
Continue PPI and repeat endoscopy in 5-8 weeks
Continue PPI and repeat endoscopy in > 8 weeks
Continue PPI and no endoscopy needed within 1 year
Other recommendation, please specify
Other recommendation, please specify
Imagine a patient who had a recent food impaction. The endoscopist in the ER did report a normal esophagus during endoscopy for food impaction. However, histology showed 30 Eos/HPF in the distal and 0 Eos/HPF in the proximal esophagus. You are now consulted on your opinion regarding best management of this patient, who did not receive any treatment so far after endoscopy. What would you suggest:
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no treatment and no further procedures as long the patient will not have any future events of dysphagia or food impaction
no treatment at the current stage, schedule consultation
no treatment at the current stage, schedule consultation & endoscopy/biopsies (off treatment)
promptly initiate PPI, schedule consultation but no endoscopy
promptly initiate PPI, schedule consultation and endoscopy/biopsies (on PPI)
promptly initiate swallowed topical corticosteroids, schedule consultation but no endoscopy
promptly initiate swallowed topical corticosteroids, schedule consultation and endoscopy/biopsies (on swallowed topical corticosteroids)
As a general rule, should a repeat endoscopy be done after an EFI?
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Yes, always
Only if stricture/narrowing was seen
Only if diagnostic biopsies were not taken during the emergency endoscopy
Only after initiating treatment in order to monitor the response to therapy
Only if symptoms reappear
No, not necessary
What type of follow-up should occur after an EFI (index or recurrent)?
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When should a first follow-up be done?
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Not necessary
Within 1 week after bolus removal
Within 1 month after bolus removal
Within 1 year after bolus removal
In case of bolus that spontaneously passes in the ER before endoscopy (in a patient who has never had an endoscopy), what management do you recommend?
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Perform an endoscopy during the present ER visit or admission
Provide an appointment for an endoscopy within 1 weeks
Provide an appointment for an endoscopy within 2 weeks
Provide an appointment for an endoscopy within 4 weeks
Provide an appointment for an endoscopy within 12 weeks
No endoscopy needed but clinical follow-up within a month
No follow-up needed
How many years ago did you complete gastroenterology training?
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0-5 years
6-14 years
15-24 years
>24 years
Approximately how many EoE patients do you see per month?
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0-1 EoE patients
2-10 EoE patients
11-20 EoE patients
>20 EoE patients
In which country do you work as gastroenterologist?
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What best describes your primary practice type
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Hospital-based setting
Private-based setting
