Glucagon for Relief of Acute Esophageal Foreign Bodies and Food Impactions: A Systematic Review and Meta-Analysis

Glucagon is frequently used for the relief of esophageal impactions. This systematic review and meta-analysis were performed to evaluate the efficacy and safety of glucagon for acute esophageal foreign body and food impactions. PubMed, CINAHL, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched from inception to March 1, 2018. Retrospective, observational, and randomized controlled trials assessing glucagon for the relief of acute esophageal foreign body and food impaction were included. There were no language or age restrictions. Only studies conducted on humans and with a comparator (e.g., control or placebo) were included. Study quality analysis was performed using the Cochrane Risk of Bias tool. Quality of evidence analysis was performed using the Grading of Recommendations, Assessment, Development and Evaluations approach. A total of 1988 studies were identified, and five studies with a total of 1185 subjects were included. Treatment success occurred in 213 of 706 (30.2%) patients in the glucagon group and 158 of 479 (33.0%) patients in the control group (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.69-1.17, p=0.42). There was minimal statistical heterogeneity (I-2 = 14%, p=0.33). No publication bias was identified. Adverse events were identified in 24 (15.0%) patients in the glucagon group and 0 (0%) patients in the placebo group (risk difference [RD] 0.18, 95% CI 0.03-0.33, p=0.02). Vomiting events occurred more frequently in the glucagon group (17 of 160 [10.6%] vs 0 of 53 [0%]) but was not statistically significant (RD 0.07, 95% CI -0.03-0.17, p=0.19). Glucagon was not associated with a difference in treatment success but had a higher rate of adverse events for the treatment of esophageal foreign body and food impaction. Further controlled studies are needed to confirm the efficacy of glucagon with adequate power to assess adverse events.