Myth: glucagon is an effective first-line therapy for esophageal foreign body impaction.

Esophageal foreign body impactions (EFBIs) are relatively rare in emergency medicine; patients rarely have them more than once. Indications for watchful waiting include a patent airway and the ability to clear secretions. However, in many cases, significant discomfort combined with patient expectations mandate early intervention to dislodge the foreign body. Endoscopy is the preferred definitive method of intervention for EFBI; however, most emergency physicians choose to apply one of several less invasive modes of therapy as firstline treatment. Pharmacologic agents that have been described for this purpose include glucagon, nifedipine, sublingual nitroglycerin, proteolytic enzymes and benzodiazepines. Among these, glucagon has become the most widely accepted in clinical practice. Glucagon acts by relaxing the smooth musculature of the lower esophagus, thereby reducing the resting pressure of the lower esophageal sphincter. Thus esophageal obstructions at the level of the lower esophageal sphincter (T10), which is the third most common site of obstruction in the esophagus, may be alleviated by glucagon. Despite this hypothetical advantage, there is no high-quality data to support the use of glucagon for EFBI. In this paper, we review the published literature on this topic to illustrate the myth that glucagon is an effective first-line therapy for EFBI. Methods