Individualized endoscopic management strategy for impacting jujube pits in the upper gastrointestinal tract: a 3-year single-center experience in northern China

Abstract

Background Impaction of jujube pits in the upper gastrointestinal (GI) tract is a special clinical condition in the northern Chinese population. Endoscopic removal is the preferred therapy, but there is no consensus on the management strategies. We reported our individualized endoscopic strategies on the jujube pits impacted in the upper GI tract. Methods In this retrospective study, we included 191 patients (male: 57; female: 134) who presented to our hospital with ingestion of jujube pits between January 2015 and December 2017. Demographic information, times of hospital visiting, locations of jujube pits, endoscopic procedures, post-extraction endoscopic characteristics were analyzed. Management strategies including sufficient suction, repeated irrigation, jejunal nutrition and gastrointestinal decompression were given based on post-extraction endoscopic characteristics and impacted locations. Results Peak incidence was in the second quarter of each year (85/191 cases, 44.5%). Among the 191 cases, 169 (88.5%) showed pits impaction in the esophagus, 20 (10.5%) in the prepyloric region and 2 (1.0%) in the duodenal bulb. A total of 185 patients (96.9%) had pits removed with alligator jaw forceps, and 6 (3.1%) underwent suction removal with transparent caps placed over the end of the endoscope to prevent injury on removal of these pits with two sharp painted edges. Post-extraction endoscopic manifestations included mucosal erosion (26.7%), mucosa laceration (24.6%), ulceration with a white coating (18.9%) and penetrating trauma with pus cavity formation (29.8%). All patients received individualized endoscopic and subsequent management strategies and showed good outcomes. Conclusions Individualized endoscopic management for impacted jujube pits in the upper GI tract based on post-extraction endoscopic characteristics and impacted locations was safe, effective, and minimally invasive.

Emergency Removal of Ingested Foreign Bodies in 586 Adults at a Single Hospital in China According to the European Society of Gastrointestinal Endoscopy (ESGE) Recommendations: A 10-Year Retrospective Study

“…However, in Asian countries, sharp objects, including fish bones, chicken bones, fruit pits, and dentures are the most commonly ingested objects [ 4 , 7 , 14 – 16 ]. Fish bones are the most common foreign body in South China, while jujube pit is most common in northwest China [ 10 , 14 – 16 ]. Jujube is a dark red plumlike fruit of Old-World buckthorn trees, and jujube pits usually have 2 sharp points that can penetrate the wall of the GI tract ( Figure 7A–7C ) [ 10 ].…”

“…Fish bones are the most common foreign body in South China, while jujube pit is most common in northwest China [ 10 , 14 – 16 ]. Jujube is a dark red plumlike fruit of Old-World buckthorn trees, and jujube pits usually have 2 sharp points that can penetrate the wall of the GI tract ( Figure 7A–7C ) [ 10 ]. Our observation on jujube pits ingestion may be because of the high consumption of jujube in northwest China.…”

“…The reported complication rate in some studies was as high as 50% [ 4 – 7 ] and the major complication rate was about 7.3–25.8% [ 4 , 5 , 7 – 9 ]: laceration 9.1–16% [ 4 , 6 , 7 , 9 ]), perforation 1.5–8.1% [ 4 – 7 , 9 ]), and hemorrhage 3.4–5.0% [ 6 , 9 ]). The most frequently reported risk factors for complication were time interval between ingestion and endoscopic management, and the sharpness of the foreign body [ 7 , 10 ]. The rate of perforation caused by ingested sharp-pointed objects was 35% [ 11 ].…”

Surgical Management In Accidental Ingestion of Jujube Pits in Children

“…Transient fasting and intravenous application of antibiotics would help to control the in ammation and promotes healing. Several studies have been reported about management of jujube pits impactions using endoscopy on adults [16][17][18]. Although endoscopy was con rmed as the most effective technique in detecting, locating and removing FBs [19].…”

Utility of CT in detecting and monitoring subphrenic jujube pits: a retrospective cross-sectional study of clinical cases and ex vivo experiments

“…The pulp and pit cannot be easily separated, which leads to involuntary and accidental deglutition of jujube pits (4). Most jujube pits are embedded in the esophagus and can be detected and removed by endoscopy (5); hence, subphrenic jujube pits are relatively rare. A few studies have reported subdiaphragmatic jujube pit foreign bodies, to our knowledge, totaling 45 patients with jujube pits located in the subphrenic digestive tract (stomach, n=20; small intestine, n=22; colon, n=1; rectum, n=2) were reported worldwide (5)(6)(7)(8)(9)(10).…”