In adults in Western countries, foreign body ingestion typically presents as esophageal food impaction (EFI), often associated with underlying esophageal pathology, that should be diagnosed [1, 2]. We retrospectively analyzed endoscopic management, techniques (push vs. pull), and outcomes of EFI. Special attention was given to the prevalence of eosinophilic esophagitis (EoE) and the role of mucosal biopsies in diagnosis and management.

We conducted a retrospective analysis of EFI cases using the hospital endoscopy database (OPS code 8-100.6) from 01/2020–09/2025. Outcomes included EFI frequency, endoscopic techniques, complication rates (minor vs. major), prevalence of EoE, baseline characteristics, aspiration, 30-day mortality, and biopsy rates during index endoscopy or short-term follow-up.

Of 109 cases identified, 32 were excluded, leaving 77 for analysis. Patients were at 77.92% male, mean age 63 years. Hospital admission occurred in 41.56%, with 53.25% discharged and 5.2% treated during hospitalization. Endoscopic management used the push technique in 54.55% and the pull technique in 41.56%; in 11.69%, the technique was unspecified. Overall complications occurred in 11.69% (push 7.14%, pull 15.625%, with respect to the respective technique), aspiration in 2.6%, and mortality was 1.3%. Biopsies were performed in 66.23%, revealing underlying EoE in 15.58% of patients.

Consistent with other data, we also showed that EFI predominantly affects adult men [3]. The push-technique, said to be the primary technique, was applied more frequently than the pull-technique [1, 2, 4]. Complication rates were higher than previously reported, slightly more frequent with pull [3]. Biopsies revealed EoE in a substantial proportion, underscoring their importance during index endoscopy when the underlying cause is unclear. Although the push-technique seems to be associated with less complications and therefore the primary technique, endoscopic management should be individualized based on patient condition and clinical context.