Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic.

The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed.

In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity.

Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance.

Review of the literature on the role of surgery in the management of head and neck cancer in the era of organ preservation.

Literature search based on the essential practice guidelines set out by the US National Comprehensive Cancer Network.

Despite the increasing popularity of non-surgical treatment options, the surgeon remains a key figure in the multidisciplinary head and neck cancer team, along with the radiation oncologist, the medical oncologist and the speech and swallowing therapist. Even when organ preservation is successful, early and late toxicity may cause serious complications, including laryngeal dysfunction with a ‘frozen larynx’. When organ preservation fails, salvage surgery is often associated with increased complications and reduced survival.

There is a definite need to apply more rigorous standards to the use of organ preservation strategies, and to re-evaluate the role of surgery in head and neck cancer treatment.