A New Trend in the Management of Esophageal Foreign Body

Abstract

The introduction of transnasal esophagoscopy has changed the diagnosis and management for an esophageal foreign body. Transnasal esophagoscopy is a quick and safe procedure that can be performed under local anesthesia. Transnasal esophagoscopy could replace lateral neck X-ray to become the initial screening procedure and a useful treatment for patients with an esophageal foreign body.

Diagnostic Performance of Conventional X-ray for Detecting Foreign Bodies in the Upper Digestive Tract: A Systematic Review and Diagnostic Meta-Analysis

“…Of these 61 studies, 44 were excluded (12 were case reports or series and letters, 1 was a cadaver study, 1 was a review, 6 excluded the target population, 6 did not include the index test of interest, and 7 did not examine the outcome of interest). Finally, 17 studies that met the inclusion criteria were included [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Among 17 studies, 14 [ 4 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 21 , 22 ] were performed in Asia, 2 [ 8 , 20 ] in Europe, and 1 [ 10 ] in Australia. A total of 5 studies [ 4 , 16 , 19 , 20 , 21 ] were prospective, 11 [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 17 , 18 , 22 ] were retrospective, and 1 [ 7 ] was a case–control study. Regarding the study setting, six studies recruited patients only from the ED, three recruited only hospitalized patients, three included patients from the ED or outpatient department or hospitalized patients, and five did not provide clear information.…”

“…Regarding the study setting, six studies recruited patients only from the ED, three recruited only hospitalized patients, three included patients from the ED or outpatient department or hospitalized patients, and five did not provide clear information. Regarding inclusion criteria, seven studies [ 4 , 8 , 10 , 13 , 17 , 21 , 22 ] focused on the ingestion of fish bones and seven [ 7 , 9 , 12 , 15 , 16 , 17 , 21 ] focused on esophageal FBs. The sample sizes of studies ranged from 45 to 1338.…”

“…The mean age of included participants ranged from 5.2 to 57 years. Eight studies [ 7 , 9 , 11 , 12 , 13 , 15 , 19 , 21 ] recruited more men than women, seven [ 4 , 8 , 10 , 14 , 17 , 18 , 20 ] recruited more women than men, and two did not provide information regarding the number of men and women included in the study. In terms of the index test, eight studies used conventional radiography, including anterior–posterior and lateral cervical X-ray, posterior–anterior and lateral chest X-ray, and abdominal X-ray.…”

“…The conventional X-ray is usually used as the first-line imaging modality to detect FBs. Although several studies [ 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] have investigated the use of conventional X-rays for detecting FBs, they have reported inconsistent results in terms of diagnostic performance, with sensitivity ranging from 15% to more than 90% [ 7 , 19 ] and specificity ranging from 50% to 100% [ 7 , 8 ]. The American Society for Gastrointestinal Endoscopy and the European Society for Gastrointestinal Endoscopy (ESGE) guidelines strongly recommend using conventional X-rays to detect the presence, location, size, configuration, and the number of ingested FBs if the ingestion of radiopaque objects is suspected or if the type of object is unknown.…”