Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults

Geraci, Girolamo; Sciumè, C; Carlo, Giovanni Di; Picciurro, Antonino; Modica, Giuseppe

doi:10.1186/s12873-016-0104-3

Cited by 43 publications

(64 citation statements)

References 13 publications

(31 reference statements)

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“…15 Lower adverse event rates were also found in some other retrospective studies that reported their occurrence in less than 10%. 1 Regarding treatment strategies, foreign body forceps was the preferred instrument in FBI while retrieval basket was preferred in FI, although mobilisation alone was sufficient in a quarter of cases. We also found that in FI the use of more than one instrument is more likely, suggesting that the whole array of endoscopic instruments should be promptly available if FI is suspected.…”

Section: Discussionmentioning

confidence: 99%

“…Although FBI and FI are frequent emergencies, studies evaluating treatment strategies and their outcomes are scarce and the majority is retrospective. [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.…”

Section: Introductionmentioning

confidence: 99%

“…[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. Indeed, recent European guidelines report that although 10-20% of ingested foreign bodies require endoscopic removal, 80-90% of them spontaneously pass the gastrointestinal tract, 7 and thus a significant proportion would not benefit from endoscopy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…However, once the foreign bodies pass through the esophagus, symptoms associated with the foreign body is rare. [5] In the present case, even though the patient did not complain of vomiting, the large number of pebbles and coins in his stomach caused him abdominal pain.…”

Section: Discussionmentioning

confidence: 42%

Surgical Removal of Multiple Gastric Foreign Bodies. Case Report

Choi¹

2019

AJMCR

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In the adult population, psychiatric disorders and mental retardation are risk factors for foreign body ingestion. Most cases of foreign body ingestion are managed by close observation or endoscopic intervention. However, surgical intervention is mandatory in some cases. Here, we present the case of an unusually huge amount of gastric foreign bodies, which were removed by surgical intervention. A 54-year-old male patient presented with epigastric pain. He was born with mental retardation and had a 10-year history of anxiety disorder. Before the presentation, a colonic foreign body (coin) was identified 5 months ago, and the foreign body had been passed through the colon without morbidity. Plain radiography showed several foreign bodies occupying the whole stomach, and computed tomography showed multiple oval-shaped radiopaque foreign bodies in the stomach without complications. Although gastroscopy was attempted to extract these foreign bodies, it was impossible to extract all of them. Thus, surgery was performed. The foreign bodies (pebbles and coins) were extracted by surgery, and plain radiography was performed to confirm that there were no residual foreign bodies. The postoperative course was uneventful. Three months after the surgery, a radiopaque round foreign body was detected, and it was resolved without any intervention. Thereafter, the patient course was uneventful during the 1-year follow-up. Although a case with such a large number of gastric foreign bodies is extremely rare in humans, it is important to have a close follow-up after the removal of foreign bodies in patients with psychiatric disorders.

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“…1,2 Furthermore, serious complications of therapeutic endoscopy for FBO such as perforation are rare, with rates of perforation <1%, while other complications, for example mucosal laceration or aspiration, may occur in up to 5% of cases. 1,2,7 Complication rates are higher when the interval between impaction and endoscopy exceeds 24 h, 8 and consequently early endoscopic therapy is recommended by international guidelines. 9,10 Despite the efficacy of endoscopy as the primary intervention for FBO, conservative approaches to the management of FBO are common.…”

Section: Introductionmentioning

confidence: 99%

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

Fulforth

Chen

Falvey

2019

Emerg Medicine Australasia

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Objective To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. Methods A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. Results A total of 116 patients presented with symptoms of FBO. Twenty‐seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy‐one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). Conclusions Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.

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Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults

Cited by 43 publications

References 13 publications

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

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

Surgical Removal of Multiple Gastric Foreign Bodies. Case Report

Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction

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