Letter to the Editor

Abstract

et al. 1 The study has been well planned and executed. I agree with the authors' conclusion and would like to add some more points to it through your prestigious journal. The utility of x-rays in diagnosing foreign body impactions in the pharynx and esophagus has also been evaluated in previous studies, with all of them concluding that x-rays have low sensitivity and specificity for the same. 2-4 There are studies that have compared other modalities of detection of foreign bodies like computed tomography (CT) scan and upper gastrointestinal endoscopy, especially transnasal flexible esophagoscopy. Computed tomography scan has been found to have high sensitivity and specificity for detecting foreign bodies 2-4 ; however, it has drawbacks of increased cost and radiation exposure. The modern low radiation CT scans expose the patients to very minimal radiation and have proven to be safe. Transnasal flexible esophagoscopy is a safe and effective procedure, which can be done under sedation and has high sensitivity and specificity. 5 It has the added advantage of no radiation exposure, and the foreign body can be removed in the same setting. Fish and chicken bones are not only the most common foreign bodies we encounter, they are also the ones that are prone to cause extensive damage and complications; therefore, their detection and early removal is a matter of utmost importance. In such a situation, plain x-ray films cannot be recommended because they lack specificity and sensitivity. A randomized control trial can be designed in the future comparing the sensitivity, specificity, cost effectiveness, and safety of low radiation CT scan and transnasal flexible esophagoscopy for determining the best modality for diagnosing these foreign bodies.