Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature

Abstract

Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist.

Foreign body ingestion and food impaction in adults: better to scope than to wait

“…[1][2][3][4] Indeed, the need to perform radiological exams before endoscopy, the endoscopic methods used to retrieve the foreign body or FI and the postendoscopy attitude are generally decided on a case by case basis, based on the type, size, shape of the foreign body and also on physical examination and symptoms or signs of complications. [5][6][7][8][9][10] This contributes to significant heterogeneity in attitudes and also in their reporting, with some studies reporting FBI and FI therapeutics and outcomes together although they are different entities. [1][2][3] Endoscopy is the mainstay of diagnosis and treatment of FBI and FI, although some controversies exist concerning the indications and the best timing for its execution.…”

Endoscopic management of foreign bodies in the upper gastrointestinal tract

“…Coins are the most common foreign body ingested by children. 5,6 Nearly 30% pass into the stomach within 24 hours. If the object is less than 2cm in size it passes through entire GI tract.…”

Indications of Emergency Endoscopy

“…The procedure is indicated within 24 hours if a blunt object is stuck in the esophagus, if there is incomplete obstruction of the esophagus, or in the case of objects more than 6 cm in length in the duodenum or of magnetic objects in the duodenum or upstream. For parts or objects larger than 2.5 cm in the stomach, the button cells or cylindrical cells that remain in the stomach 48 hours after ingestion, an endoscopic gesture is necessary without urgency 9 . These recommendations are limited because the vast majority of foreign bodies present in the stomach are eliminated within 4 to 6 days after ingestion by natural routes.…”