Comparison of Outcomes in Medical Therapy vs Surgical Intervention of Esophageal Foreign Bodies

Abstract

Objectives (1) Compare efficacy of primary medical therapy vs primary surgical intervention in patients with esophageal foreign bodies (EFBs). (2) Investigate variables that may predict successful outcomes in patients treated for EFBs. Study Design Case series with chart review. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients (older than 18 years) seen at the University of Michigan Emergency Department (ED) over an 8-year period with the diagnosis of EFBs (January 1, 2003, to December 31, 2011; N = 250). Decision was made by ED physicians whether to treat patients with first-line medical therapy vs surgical intervention. Pertinent clinical and demographic data were extracted from medical records and summarized by descriptive statistics. Results First-line treatment with surgical intervention (flexible or rigid esophagoscopy with foreign body removal) was much more likely to lead to resolution of symptoms than medical therapy (glucagon alone or in combination with other medical therapy) (98% vs 28%, P < .0001). When delivered within 12 hours of symptom onset, medical therapy was more likely to be successful (34% resolution vs 12% resolution, P < .01). There was no difference in complication rates for primary medical therapy vs surgical intervention (8% vs 8%). Conclusions Patients with EFBs are a commonly encountered consultation for both otolaryngologists and gastroenterologists. In these patients, first-line surgical intervention is superior to medical therapy and should not be avoided for a trial of medical therapy or concern for higher morbidity. Implementation of these findings has the ability to positively affect treatment patterns, outcomes, and patient quality of life.

Glucagon for Relief of Acute Esophageal Foreign Bodies and Food Impactions: A Systematic Review and Meta‐Analysis

“…Given these findings, endoscopic intervention may be a preferred treatment. A recent study compared medical therapy versus endoscopic intervention and concluded first‐line endoscopic intervention was superior to medical therapy and should not be delayed for a trial of medical therapy due to concerns of higher morbidity with endoscopic intervention …”

“…This is important because vomiting may increase the risk of aspiration and possibly esophageal perforation, and the latter is known to adversely affect morbidity from esophageal obstructions . One study reported the management of adverse events from glucagon included the need for fluid resuscitation secondary to hypotension and antiemetic administration . Additionally, two patients experienced lightheadedness or near syncope but did not require medical intervention.…”

“…Next, studies used different outcome definitions of treatment success and included different esophageal foreign body impactions (e.g., food and objects); however, both assessments reflect current management in real‐world practice. Furthermore, although treatment success is known to be affected by the duration of time between ingestion and treatment, included studies did not control for time to treatment that may have influenced the outcomes. Nonetheless, the large sample size and similar probability of occurrence between groups make this less likely.…”

Retrospective Analysis of Esophageal Foreign Body Ingestion: Differences Among Weekday, Weekends, and Holidays

“… 4 Rigid esophagoscopy under general anesthesia has traditionally been used by otolaryngologists as the first-line treatment. 5 …”

Consuming consumer products and the emergency department

“…Other centers with different demographics report significantly lower rates of operative intervention. 7 From a clinical perspective, it would also be beneficial to know whether a given patient had ingested multiple objects at the same time, and this information is unfortunately not available in the National Electronic Injury Surveillance System. Dalal et al 8 evaluated their experience with 30 incarcerated patients who had 141 episodes of intentional ingestion; on average, 4.6 items were ingested per episode.…”