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

Abstract

Background and objective: To assess clinical outcomes after foreign body ingestion and food impaction; to identify predictors of foreign body presence at the time of endoscopy. Methods: A prospective study including consecutive adult patients with foreign body ingestion or suspected food impaction between May 2014 and August 2016. Results: In total, 521 patients were included, 320 with foreign body ingestion and 201 with suspected food impaction. Food impaction patients were significantly older and more frequently had a history of oesophageal disease. The foreign body was encountered in the upper digestive tract in 43% of the patients with foreign body ingestion, and food impaction was confirmed in 87%. Older age (odds ratio (OR) year 1.04, 95% confidence interval (CI) 1.02-1.06) and early presentation (OR first six hours 4.41, 95% CI 2.24-8.66) were independent predictors of foreign body presence, while a history of psychiatric disease was an independent predictor of food impaction (OR 6.69, 95% CI 1.66-26.9). Successful endoscopic treatment was achieved in more than 90% of the cases, with adverse events occurring in fewer than 5%. Foreign body forceps was the preferred device in foreign body ingestion, while retrieval basket and mobilisation were preferred in food impaction. The need to use more than one instrument was significantly higher in food impaction. Conclusion: Foreign bodies are encountered at endoscopy in almost half of the cases. Older age and earlier presentation are independent predictors of its presence. Given the high proportion of patients with foreign body at endoscopy and the low risk of complications, endoscopic evaluation is probably justified in the majority of cases.

Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients

“…And only 4 (3.1%) patients were asymptomatic, significantly less than previous studies. 14,24,29 This may due to the mix of food bolus impaction with FB ingestion in previous studies. Foreign-body ingested patients were more frequently symptomatic, while a considerable number of patients with food bolus impaction were asymptomatic.…”

“…Its clinical characteristics and management differ greatly from food bolus impaction, which happens mainly in West countries. 14 be completely relaxed under general anesthesia; (2) could reach proximal esophagus easily and provide excellent exposure, especially at the upper esophageal sphincter; and (3) provide a wider lumen and allow multiple instruments for the extraction of FB. (4) The airway is protected and (5) may be preferable for patients with inadequate cooperation such as children.…”

“…Foreign-body ingested patients were more frequently symptomatic, while a considerable number of patients with food bolus impaction were asymptomatic. 2,3,14 However, the symptom does not correlate with the severity of complication. In the present cohort, there are 4 asymptomatic patients.…”

Rare ‘kettle of fish’ in the management of foreign body ingestion: 834 fish hooks

“…The majority of foreign bodies, when found, are present in the oesophagus with meat and fish bones being the most common culprit. 1,2 Fortunately, most foreign bodies are passed spontaneously with only 10-20% requiring endoscopic or surgical intervention. [1][2][3] Endoscopic intervention is the gold standard, and current guidelines recommend emergent therapeutic oesophagogastroduodenoscopy for sharp objects lodged in the oesophagus.…”

“…1,2 Fortunately, most foreign bodies are passed spontaneously with only 10-20% requiring endoscopic or surgical intervention. [1][2][3] Endoscopic intervention is the gold standard, and current guidelines recommend emergent therapeutic oesophagogastroduodenoscopy for sharp objects lodged in the oesophagus. 3 These objects can result in significant morbidity relating to hollow viscous perforation, especially with infection to surrounding structures such as the mediastinum, peritoneum or pancreas.…”