Rigid Esophagoscopy for Foreign Body Extraction: Results and Complications in the Endoscopic Era

Abstract

Introduction Rigid esophagoscopy (RE) has long been a part of otolaryngology practice. In the past decades, the procedure was less commonly performed due to the advances and availability of flexible endoscopic techniques. This study aims to describe the outcomes of RE performed to treat foreign body ingestion and to evaluate risk factors associated with postoperative complications. Methods Patients who underwent RE to treat foreign body ingestion in an otolaryngology emergency department of a Portuguese tertiary university hospital, between 2010 and 2020, were included. A total of 162 cases were analyzed, and data was collected retrospectively. Results The most common foreign bodies were meat bone (31.5%, n = 47), food impaction (28.8%, n = 43), and fish bone (19.5%, n = 29). The proximal esophagus was by far the most frequent location (80%, n = 118). Esophageal perforation occurred in 8% (13 patients), and there was a 2.5% (n = 4) mortality rate. The odds ratio of an esophageal perforation if the foreign body was completely or partially located outside the proximal esophagus was 4.67 times that of a foreign body exclusively in the proximal esophagus (OR = 4.67 [95% CI: 1.39-15.72]; p = 0.016; Fisher's exact test). Conclusion RE remains an effective and important technique in the management of ingested foreign bodies, particularly if endoscopic removal is unsuccessful. Foreign body location outside the proximal esophagus was associated with esophageal perforation.

Keywords: esophageal foreign body; esophageal perforation; foreign body retrieval; rigid esophagoscopy; swallowed foreign body.

Figure 1. Types of foreign bodies

The image shows the foreign bodies identified during rigid esophagoscopy in the order of frequency.

Figure 2. Foreign body location

The proximal esophagus was the most common location (80,3%, n = 118), followed by contiguous locations (6,1%, n = 9), hypopharynx (5,4%, n = 8), middle esophagus (4.8%, n = 7), and distal esophagus (3.4%, n = 5).