Sa1207 A Retrospective Analysis of Upper Gastrointestinal Foreign Body Ingestion Among Adults: Initial Presentation, Diagnosis, Intervention and Outcome.
The natural course after foreign body (FB) ingestion is uneventful in majority of cases and an ‘intelligent neglect’ approach is favored. In a fraction of patients, FB ingestion can be a medical emergency with risk for fatal complications. Literature regarding success rates and complications of upper gastrointestinal FB extraction in adults is sparse.
As a large tertiary care teaching hospital, we retrospectively reviewed charts of patients who presented with FB ingestion from 2011-2014. Demographics, ingestion characteristics, and outcome measurements were collected. Chi-Square test was used to investigate associations between these variables.
260 patients presented with FB ingestion: 160 (61.5%) men, mean age 60 years (± 20.03), median age for accidental ingestion 61 years, purposeful ingestion 34 years. Ingestion was accidental in 95%, ingested material was food bolus in 92%, and intervention required intubation in 51% of cases. The main symptom from FB ingestion was dysphagia (94%). 22% had an underlying psychiatric disorder; depression (n=43), anxiety (n=20) and bipolar disorder (n=15). Esophageal abnormalities were present in 79% of patients at the time of endoscopy; majority was structural (92%). Incidental findings during endoscopy included stricture (35%), Schatzki’s ring (29%), hiatal hernia (25%), ringed esophagus (22%) GERD (5%), Barret’s esophagus (5%) and malignancy (4%). A biopsy was performed at the time of procedure for 90 patients; 40% of this group had ringed esophagus. Compared to patients without a ringed esophagus, those that did had a higher proportion of eosinophilic esophagitis (25% and 58%, respectively;p=0.002). Of the 260 patients, 200 patients received intervention in ER, 46 patients as inpatient and 14 patients, as outpatient. All interventions that were done in ER were successful. Success rate of inpatient procedures was 89%, outpatient 93% with overall success rate 98%. Flexible esophagogastroduodenoscopy was the mode of intervention in majority (n=252) with success rate 98%. Frequency of location of FB with outcome is shown in figure 1. Specific complications of the procedure were bleeding 1.5%, perforation 1.9% aspiration pneumonia, 1.5% and post procedure hospitalization (6.1%). There were no reports of stricture, fistula, diverticula or abscess.
Our study shows that flexible endoscopes have high success rates with minimal complications. During the study period, all patients presenting to our hospital underwent interventional endoscopy and it was found that the risk of complications was extremely low, proportion of successful removal was high, identified underlying abnormalities and facilitated biopsies. There was a statistically significant association between ringed esophagus and eosinophilic esophagitis, signifying the importance of biopsy at the time of endoscopy.
Published In/Presented At
Sreedhar, A., Kim, P., Shah, S., Macfarlan, J., & Shah, H. (2017). Sa1207 A Retrospective Analysis of Upper Gastrointestinal Foreign Body Ingestion Among Adults: Initial Presentation, Diagnosis, Intervention and Outcome. Gastrointestinal Endoscopy, 85(5), AB200. doi:10.1016/j.gie.2017.03.444
Gastroenterology | Medical Sciences | Medicine and Health Sciences
Department of Medicine, Department of Medicine Faculty