OBJECTIVE In 1990, we described a combination therapy that uses glucagon, an effervescent agent, and water to relieve acute esophageal food impaction. The initial trial showed relief of the obstruction in 12 of 16 cases without complication, so we continued the series to determine the safety and effectiveness of this technique. METHODS Between July 1987 and August 1993, a prospective trial consisting of 43 patients with 48 episodes of acute (less than 24-hr duration) food impaction in the distal two thirds of the esophagus were identified with either a barium or water-soluble contrast agent swallow. Subsequently, we attempted to relieve the obstruction by using 1 mg of IV glucagon, an effervescent agent, and water. A water-soluble esophagogram was obtained immediately in all cases to determine the response to the therapeutic intervention and to look for any complication such as perforation. RESULTS The combination therapy resulted in the clearance of food obstruction in 33 (69%) of 48 attempts. One complication, a minor mucosal laceration, occurred after two unsuccessful treatments. A lower esophageal ring was the single most common abnormality identified (n = 24). The average width of rings in the successful cases was 15.4 mm and the average in the unsuccessful cases was 13 mm. Other underlying causes of obstruction were esophagitis and stricture. CONCLUSIONS Our experience with the use of glucagon, an effervescent agent, and water to relieve acute esophageal food impaction indicates that the technique is highly successful and that serious complications are rare.