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

Abstract

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 < .001), and the complication rate increased (p < .001). Endoscopic management under general anesthesia didn't improve the success rate or lower the complication rate compared with topical pharyngeal anesthesia (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.

Keywords: Complications; endoscopy; foreign bodies; retrospective study; upper gastrointestinal tract.