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Background: Acute food bolus impaction is an emergency causing absolute dysphagia and is managed surgically by endoscopic removal. However certain conservative measures have been reported to serve the purpose and relieve the impaction. Objective: To assess the efficacy of conservative (non pharmacological/pharmacological) management of acute esophageal food bolus impaction before proceeding to definitive endoscopic treatment. Study design: Hospital based cross sectional Place and duration of study: Departments of Otorhinolaryngology Nishtar Medical University, Multan and Bahawal Victoria Hospital, Bahawalpur, from 1st January, 2022 to 30th June, 2022. Material and Methods: A total of 45 patients with confirmed food bolus impaction were included in the study after informed verbal consent of the participants. Conservative management was initiated before endoscopy. Endoscopy was performed in all the patients who were fit for general anesthesia. Age, gender, effects of non-pharmacological (carbonated beverages), pharmacological (calcium channel blockers, nitrates) agents and endoscopic procedure with associated pathology were documented. Data was put in SPSS 23 and analyzed. Mean, standard deviation and range were calculated for age. Percentages were calculated for gender, pharmacological and non-pharmacological agents, endoscopic procedure and underlying pathology. Results: Carbonated beverages (Cola drink), Calcium channel blocker (Nifedipine) and nitrate (Isosorbide dinitrate) could be given to 37.8%, 17.8%, 20% patients respectively with success rate in 35.2% (12) patients. With endoscopy food bolus was pulled with polypectomy snares, dormia basket, retrieval forceps and roth net in 18.1% (6), 24.2% (8), 27.2% (9), 9% (3) patients respectively. Food bolus was pushed intact into the stomach in 6% (2) patients and pushed after the fragmentation in 15.1% (5) patients. Schatzki ring, esophageal stricture, achalasia and hiatal hernia were present in 8.9% (4), 28.9% (13), 15.5% (7) and 20% (9) patients respectively. Conclusion: Acute food bolus impaction can be treated conservatively with non pharmacological/pharmacological agents in certain cases before doing definitive endoscopic relieve of the obstruction. [ABSTRACT FROM AUTHOR]