Document resource
Introduction Food bolus obstruction is a common presentation to endoscopy services and is frequently associated with eosinophilic oesophagitis (EoE). Current guidelines recommend routine multi-level oesophageal biopsies in these patients to avoid missed diagnoses and ensure appropriate follow-up.Methods We performed a retrospective audit of all patients referred for suspected food bolus obstruction across three hospitals in Betsi Cadwaladr University Health Board between July 2023 and July 2025. Data were extracted from endoscopy and pathology systems, including timing of OGD, presence of a food bolus, biopsy practice, biopsy location, histological diagnosis, and gastroenterology referral for confirmed EoE. Compliance was assessed against local standards recommending OGD within 24 hours, biopsies regardless of endoscopic appearance, and sampling from at least two oesophageal levels.Results Sixty-two patients underwent OGD for suspected food bolus obstruction. Only 22 (35%) had a food bolus present at endoscopy. Oesophageal biopsies were taken in 29/62 cases (47%), with full multi-level biopsies performed in only 3–4 patients. Histology was available for 27 patients, of whom 9 (14.5% of the total cohort) were diagnosed with EoE. Referral to gastroenterology occurred in 8/9 EoE-positive cases. Delays beyond 24 hours to OGD occurred in a significant proportion, particularly where patients were referred for elective rather than urgent endoscopy.Conclusions Less than half of patients undergoing OGD for suspected food bolus obstruction received oesophageal biopsies, and very few had guideline-recommended multi-level sampling. Despite this, a substantial proportion were diagnosed with EoE, highlighting the risk of missed pathology when biopsies are omitted. Targeted education and the Introduction of a standardised food bolus pathway may improve biopsy compliance, EoE detection, and appropriate specialist referral.