What Predictive Parameters Best Indicate the Need for Emergent Gastrointestinal Endoscopy After Foreign Body Ingestion?

Abstract

Our aim was to determine what parameters may be used to indicate an emergent endoscopy after foreign body (FB) ingestion and to ascertain how often FBs are found endoscopically. Demographic data, gastroesophageal antecedents, clinical and endoscopic data, and complications were obtained. We examined 122 patients endoscopically. The onset of symptoms was immediate after FB ingestion in 93% of patients. Dysphagia was the most frequent symptom (66%), with the pharynx the most frequent location of impaction (71%). Endoscopy confirmed the presence of FBs in 52% of patients. Extraction was performed in 78%. The immediate onset of symptoms, dysphagia, and the absence of pharynx localization of impaction were predictive indicators of a positive FB finding (p < 0.05), with diagnostic sensitivity of 86% and specificity of 63%. Upper endoscopy should be performed in all patients with FB ingestion, even though no FB was found in 48%.

Endoscopic Techniques and Management of Foreign Body Ingestion and Food Bolus Impaction in the Upper Gastrointestinal Tract: A Retrospective Analysis of 139 Cases

“…This figure is comparable with some eastern 4,10 and western 5,7,11 reported series, and differs from other reports 12,13 where endoscopy revealed the foreign body in only 52% and 64.5% of the patients. There are numerous reasons for this inconsistency, such as: the nature of the most common foreign bodies and food boluses, because the rate of spontaneous passage is related to the size and type of foreign body and food bolus; the incidence of the underlying esophageal disorders inducing stenosis, which obviously prevents spontaneous passage of the foreign body and food bolus; and finally the timing of the endoscopic procedure, because the chance of the foreign body passage through the GI tract spontaneously increases as time passes.…”

The Management of Ingested Foreign Bodies in an Ear, Nose, and Throat Emergency Unit: Prospective Study of 204 Cases

“…Pocos estudios previos han evaluado los factores clínicos que predicen la retirada del cuerpo extraño ingerido. Ciriza et al hallaron que la aparición inmediata de los síntomas, la presencia de disfagia y la ausencia de localización faríngea de la obstrucción constituían variables independientes que predecían un cuerpo extraño en la endoscopia gastrointestinal superior 7 . Lim et al hallaron que las pruebas de disfagia, frotis laríngeo positivo y de ingesta de agua eran de alta sensibilidad y especificidad en cuanto a la ingestión de cuerpos extraños 6 .…”

Comparison of rigid and flexible endoscopy for removing esophageal foreign bodies in an emergency

“…A previous study demonstrated that the immediate onset of symptoms, dysphagia, and the absence of pharynx localization of impaction were predictive of a positive FB finding. 17 Pharyngeal innervation by the vagus and glossopharyngeal nerves provides a better sensation than in the esophagus, which is innervated less densely by the vagus and cervical sympathetic nerves. 18 By contrast, our results demonstrate that dysphagia is an important positive predictor for real existing esophageal FBs while the lumping sensation over throat and odynophagia are not.…”