Endoscopic management of suspected esophageal foreign body in adults

Abstract

Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond-24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond-24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond-24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.

Therapeutic Effect of Esophageal Foreign Body Extraction Management: Flexible versus Rigid Endoscopy in 216 Adults of Beijing

“…These data are in accordance with previous studies in adults that show an esophageal FB extraction rate of 91.4% by FE in adults [20], and reports of incidences of complications associated with endoscopic treatment of esophageal impaction ranging from 15% to 42% [21–23]. We observed a slightly higher rate of complications, possibly because we frequently (80%) found that the impacted objects in our patients were sharp FBs, such as bones, dentures, jujube pits, and pills covered by foil packages.…”

The management of oesophageal soft food bolus obstruction: a systematic review

“…Odynophagia and oesophageal ulcers: One retrospective cohort study 19 showed a significantly lower incidence of odynophagia and oesophageal ulcers in oesophageal foreign body (all types) patients treated within 24 hours. Oesophageal perforation: Soft food boluses have a lower propensity to perforate the oesophagus compared to sharp objects like bones 1 although any oesophageal foreign body compressing the mucosa for a prolonged period may theoretically cause ischaemia.…”

Unusual foreign body in the upper digestive tract: case report

“…are the most common foreign bodies ingested by adults. [4][5][6][7][8][9] Majority of the foreign bodies are radio-opaque, and requires radiological screening the entire gastro-intestinal tract particularly in children and psychiatric patient for detection of multiple foreign body.…”