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Answer 5
  1. Upper endoscopy to remove the food bolus from the esophagus. The patient has a symptomatic food bolus impaction. If the food bolus is not removed, the patient is at risk for aspiration and esophageal injury, including perforation. Observation alone would be inadequate given this patient’s overall clinical situation. A contrast study is not required given this patient’s history and examination finding and would only increase the risk of aspiration. Glucagon use could be considered as a smooth muscle relaxant but is less likely to be helpful in patients with meat impaction and a known anatomic abnormality (Schatzki’s ring). Upper endoscopy is the procedure of choice in this situation to either remove the food bolus or gently advance the bolus into the stomach. Also, the Schatzki’s ring could be assessed at the time of endoscopy. Surgery would be considered only if endoscopy failed to remove the bolus or if the patient developed a complication.

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