Table 2

Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Cavo JW Jr et al, 1977, US90 patients with oesophageal meat impaction: 44 patients received caroid solution (papain) 37 patients received papain 8 patients received various enzymes 1 patient received Adolph’s meat tenderiser (papain)Case reviewPassage of the impacted meat ComplicationsBolus successfully passed in 89 cases Bolus not passed in 1 case 2 patients died (oesophageal perforation, mediastinitis, and great vessel perforation)Most cases given barium before enzymes. Dose of enzyme given varied between studies Some studies retrospective. Not all studies treated consecutive patients. One of the patients who died from perforation had meat impaction for 10 days before presentation.
Hall ML and Huseby JS, 1988, USA1 patient with oesophageal meat impaction Adolph’s meat tenderiser (papain)Case reportPassage of the impacted meat ComplicationsMeat bolus not passed Haemorrhagic pulmonary oedemaGiven barium before enzymes Given meperidine, glucagon and diazepam after enzyme, then intubated
Maini S et al, 2001, UK1 patient with oesophageal meat impactionCase reportPassage of the impacted meatSuccessfully passed
PapainComplicationsAspiration pneumonitis