Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases

Objective: To report our endoscopic outcomes and explore the effects of duration of impaction and anesthetic methods on the endoscopic removal of foreign bodies in the upper gastrointestinal tract.

Methods: All consecutive patients with suspected foreign body (FB) ingestion between January 2013 and June 2016 were enrolled. Demographic, clinical and endoscopic data were collected and analyzed.

Results: A total of 1294 patients aged seven months to 94 years were enrolled. Odynophagia (415 cases, 32.1%), FB sensation (340 cases, 26.3%) and sore throat (267 cases, 20.1%) were the most frequent complaints. The duration of FB impaction ranged from 4?h to over two years. Anatomically, foreign bodies were most commonly located in the esophagus (n?=?1025, 86.9%). Bony foreign bodies comprised the majority of identified foreign bodies. The most common underlying pathology was esophageal stricture (38 cases, 53.5%). Nearly half of the patients (49.9%) developed complications. As the duration of impaction increased, the success rate by endoscopy decreased (p?p?p?=?.793 and p?=?.085). Age?≥60, duration of impaction longer than one day, impaction in the esophagus, and sharp foreign bodies were identified as risk factors for complications.

Conclusions: Delayed flexible endoscopy in patients, especially elderly patients, with sharp FB impactions in the esophagus results in worse endoscopic outcomes. Endoscopic management under general anesthesia did not improve the therapeutic results compared with topical pharyngeal anesthesia.     

Endoscopic management of foreign bodies in the digestive tract

From 1983 to 1989, the Unidad de Endoscopias has attended 424 cases of foreign bodies located in the gastrointestinal tract, most of them in the esophagus. The mean age of the patients was 49 years. The commonest foreign bodies were food particles and the most common symptom was acute dysphagia. The most frequent localization of impaction was the cricopharyngeal sphincter (Killian's mouth). In 89% of the cases the foreign body could be removed endoscopically. The most common underlying pathology was hiatal hernia. There were severe complications related to the presence of the foreign body in 4.5% of the cases; one death was due to aorto-esophageal fistula. Foreign bodies, mainly impacted food particles (p less than 0.001), are most frequent in patients over 65, mainly females (p less than 0.01).     

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies – impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign‐body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.     

Endoscopic removal of foreign bodies:A retrospective study in Japan

BACKGROUND The ingestion of foreign bodies(FBs) and food bolus impaction(FBI) in the digestive tract are commonly encountered clinical problems.Methods to handle such problems continue to evolve offering advantages,such as the avoidance of surgery,reduced cost,improved visualization,reduced morbidity,and high removal success rate.However,to date,no studies have evaluated the endoscopic management of FBs in Japan.AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI.METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018.Data were collected from medical charts,and endoscopic details were collected from an endoscopic reporting system.Procedures performed with a flexible gastrointestinal endoscope were only taken into account.Patients who underwent a technique involving FB or FBI from the digestive tract were only included.Data on patient sex,patient age,outpatient,inpatient,FB type,FB location,procedure time,procedure type,removal device type,success,and technical complications were reviewed and analyzed retrospectively.RESULTS Among the 215 procedures,136(63.3%) were performed in old adults(≥ 60 years),180(83.7%) procedures were performed in outpatients.The most common type of FBs were press-through-pack(PTP) medications [72(33.5%) cases],FBI[47(21.9%)],Anisakis parasite(AP) [41(19.1%) cases].Most FBs were located in the esophagus [130(60.5%) cases] followed by the stomach [68(31.6%) cases].AP was commonly found in the stomach [39(57.4%) cases],and it was removed using biopsy forceps in 97.5% of the cases.The most common FBs according to anatomical location were PTP medications(40%) and dental prostheses(DP)(40%) in the laryngopharynx,PTP(48.5%) in the esophagus,AP(57.4%) in the stomach,DP(37.5%) in the small intestine and video capsule endoscopy device(75%) in the colon.A transparent cap with grasping forceps was the most commonly used device [82(38.1%) cases].The success rate of the procedure was100%,and complication were observed in only one case(0.5%).CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.     

Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China

BACKGROUND: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. OBJECTIVE: To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients. SETTING AND PATIENTS: Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. INTERVENTIONS: All patients underwent endoscopic procedure after admission. MAIN OUTCOME MEASUREMENTS: Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. RESULTS: A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). CONCLUSIONS: Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.     

复杂上消化道异物的内镜处理

目的 积累内镜下处理复杂上消化道异物的经验.方法 分析我院2000年2月～2010年2月对67例复杂上消化道异物内镜处理情况.结果 67例患者中共有87件异物,其中有58例74件异物经内镜成功取出,尚有9例13件异物未取出.取出异物例数成功率为86.57%,取出异物件数成功率为85.06%,未出现严重并发症.结论 内镜下取复杂上消化道异物安全、有效.     

内镜治疗消化道异物262例

目的总结消化道异物在内镜下的处理经验．方法１９８９年～１９９６年０３月消化道异物２６２例，男１７４例，女８８例；年龄１０月龄～７９岁；部位在食管内８４例，胃内１６７例，十二指肠６例，回肠２例，大肠３例．在内镜直视下按照异物的形态和大小，选择适合的异物钳，取出异物１８８例，设法让异物通过肠道排出体外６９例．结果２６２例患者中２５７例通过上述方法治疗后取得满意疗效，取出异物１８８例、排出异物６９例．仅５例治疗失败后（取出失败３例，排出失败２例）改为手术处理．内镜治疗消化道异物成功率为９８１％．结论经内镜治疗除空回肠以外的消化道异物是一种安全、有效的方法．     

Endoscopic management of foreign bodies in the upper gastrointestinal tract:A review

Foreign body ingestion is a common condition, es-pecially among children who represent 80% of these emergencies. The most frequently ingested foreign bodies in children are coins, toys, magnets and batter-ies. Most foreign body ingestions in adults occur while eating, leading to either bone or meat bolus impaction. Flexible endoscopy is the therapeutic method of choice for relieving food impaction and removing true foreign bodies with a success rate of over 95% and with mini-mal complications. This review describes a comprehen-sive approach towards patients presenting with foreign body ingestion. Recommendations are based on a review of the literature and extensive personal experi-ence.     

Endoscopic removal of foreign bodies in children

The ingestion of foreign bodies such as coins, fish bones, plastic toy parts, batteries, and needles is common in children. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children require either nonsurgical or surgical intervention. The medical records of children who presented to the pediatric emergency department of a single tertiary referral center between December 2001 and May 2006 were reviewed. A total of 87 patients underwent an endoscopic procedure because of suspected foreign body ingestion and foreign bodies were identified by endoscopy in 74 patients (85.1%). The mean age of these 74 patients was 3.4 years (range, 6 months to 13 years). The most common site of foreign body lodgement was the esophagus (n = 38, 51.4%); other sites included the stomach (n = 33, 44.6%) and duodenum (n = 3, 4.0%). The types of foreign bodies included coins (n = 42, 56.8%), button batteries (n = 16, 21.6%), sharp objects (n = 9, 12.2%), chicken bones (n = 2, 2.7%) and others (n = 5, 6.7%). Only two foreign bodies (button batteries) in the duodenum could not be removed successfully by endoscopy. Instead, they were moved into the intestine and then eliminated spontaneously the following day. There were no major complications caused by foreign body ingestion or endoscopic procedures. The outcome of all patients was uneventful without morbidity or mortality. In our experience, endoscopic removal of foreign bodies under general anesthesia is an effective and safe method in children; the method also prevents erosion and perforation of the gastrointestinal tract.     

Bronchoscopic removal of foreign bodies in children: retrospective analysis of 822 cases

At the Department of Thoracic and Cardiovascular Surgery of Hacettepe University, a total number of 822 pediatric bronchoscopies were performed from 1984 through 1990 for suspected foreign body aspiration. Of the children 65.3% were boys and 34.7% were girls ranging in age from one month to 14 years. Definitive statement of foreign-body aspiration was obtained from 394 patients. Unilateral hyperaeration, atelectasis, and unilateral parenchymal infiltration were the most common radiological findings. In all endoscopic procedures, a pediatric rigid bronchoscope was used under general anesthesia and controlled ventilation. Foreign bodies were found in 77.7% of the 822 patients. In the rest of the children inflammatory disorders were confirmed. The foreign bodies most commonly found in 639 patients were sun-flower seeds (21.1%), beans (10.4%), water-melon seeds (10%), and hazelnuts (9.8%). In our presented series, the incidence of non-fatal complication was 1.8%, apart from these patients 5 of them (0.6%) died after the bronchoscopic procedures.     

Endoscopic retrieval of foreign bodies from the rectum

A technique is described and illustrated by case reports wherein removal of foreign bodies of the rectum is simplified by using the flexible sigmoidscope. Evidence from the literature indicates that delayed perforation is rare in this situation, and that outpatient management would suffice for most patients.     

食管嵌顿性异物内镜治疗分析

目的 评价内镜治疗嵌顿性食管异物的有效性和安全性.方法 回顾性总结78例嵌顿性食管异物患者的病例资料,收集食管异物的种类、数量、嵌顿部位、滞留时间,相关食管病变,内镜治疗方法、治疗时间以及并发症发生情况,并对影响并发症发生及治疗时间相关因素进行统计分析.结果食管上段最易发生嵌顿(80.8％,63/78)和穿孔(66.7％,8/12);11例异物滞留时间超过24 h,其余67例不足24 h;所有患者经内镜成功取出异物(只有2例穿孔患者取出异物后转耳鼻喉科或胸外科接受进一步治疗),治疗过程中无一例死亡,主要并发症为出血(13例,16.7％),其次为黏膜撕裂伤(7例,9.0％)和穿孔(1例,1.3％),总的并发症发生率为26.9％(21/78);异物形状、滞留时间及是否穿孔是影响内镜治疗时间和并发症发生率的主要因素(P＜0.05).结论 内镜治疗嵌顿性食管异物是安全和有效的方法.已造成食管穿孔的异物,滞留时间不超过24h且CT提示食管管腔外无脓肿形成者,可首选内镜治疗.     

Endoscopic management of Barrett esophagus

Endoscopy has a vital role in the diagnosis, screening, surveillance and treatment of Barrett esophagus. Over the past few decades, tremendous advances have been made in endoscopic technology, and the management of dysplasia and early cancer in Barrett esophagus has changed radically from being surgical to organ-sparing endoscopic therapy. Proper endoscopic techniques and systematic biopsy protocols improve dysplasia detection, and endoscopic surveillance improves outcomes in patients with Barrett esophagus and dysplasia. Endoscopic treatment can be tissue acquiring (as in endoscopic mucosal resection and endoscopic submucosal dissection) or ablative (as with photodynamic therapy, radiofrequency ablation and cryotherapy). Treatment is usually multimodal, combining endoscopic resection of visible lesions with one or more mucosal ablation techniques, followed by long-term surveillance. Such treatment is safe and effective. Shared decision-making between the patient and physician is important while considering treatment for dysplasia in Barrett esophagus. Issues such as durability of response, importance of subsquamous Barrett epithelium and the optimal management strategy in patients with low-grade dysplasia and nondysplastic Barrett esophagus need to be studied further. Development of safer wide-field resection techniques, which would effectively remove all Barrett esophagus and obviate the need for long-term surveillance, is needed.     

内镜下取上消化道异物348例体会

食管、胃内异物是常见的急症,常引起食管、胃黏膜损伤,甚至引起大出血、上消化道穿孔等严重并发症。经内镜取上消化道异物简便、创伤小、成功率高,其已作为治疗上消化道异物的首选方法[1]。现将我院内镜下取上消化道异物的体会总结如下。     

Endoscopic techniques and management of foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: a retrospective analysis of 139 cases

BACKGROUND: Ingested foreign bodies and food bolus impaction are frequently seen in endoscopic practice. Successful foreign body and food bolus removal may depend on the method used, the choice of device, and the experience level of the endoscopist, although few papers report experience and outcome of tertiary centers. AIM: To investigate the effectiveness of our protocol designed for removal of ingested foreign bodies and food boluses. METHODS: We retrospectively reviewed all patients with a diagnosis of foreign body ingestion and food bolus impaction from 1994 to 2005 identified by computer search. Patients were excluded if medical record was incomplete. RESULTS: The analysis included 171 patients. Foreign bodies and impacted food boluses were found in 77 and 62 patients, respectively. In 32 cases (23%), the foreign bodies passed spontaneously through the gastrointestinal tract. The overall success rate for endoscopic management was obtained in 137 patients (98.6%). Surgical removal of a foreign body was required in only 2 cases (1.4%). According to the type and location of the foreign object and food bolus we used Dormia baskets, retrieval forceps, polypectomy snares, and all sizes of Roth net. No complications relating to the endoscopic procedure were observed; 50 patients (35.2%) had an underlying esophageal disease. CONCLUSIONS: Endoscopic removal of upper gastrointestinal tract foreign bodies and food bolus impaction is efficacious and safe. Especially the Roth net is the best device for safe retrieval of food boluses and button disc batteries.     

Endoscopic management of biliary and pancreatic ascariasis in Viet-Nam. Report of a series of 91 cases

AIM: Ascariasis is the most widespread helminthiasis in the world. Biliary and pancreatic involvement, frequently encountered in endemic areas, is a serious public health problem. Surgical management is often required. The purpose of our work was to assess the feasibility of emergency endoscopic treatment of biliary and pancreatic ascariasis in the Viet Duc hospital (Hanoi, Vietnam), and to evaluate outcome. METHODS: A prospective study conducted over a 3-year period included 91 patients with biliary and pancreatic ascariasis. Diagnosis was based on clinical findings and abdominal ultrasound and was confirmed by endoscopic procedures. RESULTS: The 91 patients, 21 males and 70 females, mean age 41 +/- 17 years, underwent endoscopic procedures to retrieve the worm. The procedure was successful in 89 patients (97.8%). Mild pancreatitis occurred in four patients who underwent biliary sphincterotomy. The mean hospital stay was 3.1 days. CONCLUSION: Endoscopic management of ascariasis is feasible, with a very low morbidity and a high rate of success. With this treatment, hospital stay is greatly shortened.