Background and Study Aims: There have so far been no prospective studies on the value of flexible endoscopy for removing foreign bodies in the upper gastrointestinal tract. This study presents a clinical analysis of accidents with foreign bodies and prospectively evaluates the effectiveness of flexible endoscopy for removing them.
Patients and Methods: A total of 105 cases of foreign-body ingestion in the upper gastrointestinal tract were evaluated, 29 (27.6 %) in children and 76 (72.4 %) in adults. Thirty patients (28.5 %) had esophageal strictures.
Results: Thirty-nine of the foreign bodies (37.1 %) consisted of food and 66 (62.9 %) were not food-related. The success rate of foreign-body extraction using only a conventional flexible endoscope and accessories for treatment was 98.0 %, and with only a polypectomy snare and rat-toothed forceps it was 91.2 %. Complications at the moment of foreign-body removal occurred in nine patients (8.6 %); there was only one (1 %) esophageal perforation. The incidence of complications related to the duration of foreign-body impaction was six (10.5 %) with foreign bodies impacted for up to 24 h, 13 (52.0 %) for those impacted for 24 - 48 h, and three (60.0 %) for those impacted for 48 - 72 h (P < 0.05).
Conclusions: The flexible endoscope is an effective and safe device for removing foreign bodies from the upper gastrointestinal tract, with a high success rate using only the polypectomy snare and the rat-toothed forceps as accessories. If foreign-body impaction lasts for more than 24 h, there is a significant increase in the incidence of complications.
References
-
1 Brady P G. Management of esophageal and gastric foreign body. In: Dimarino AJ, Benjamin SB (eds.) Gastrointestinal disease: an endoscopic approach. London; Blackwell Science 1997: 407-417
-
2
Webb W A.
Management of foreign bodies of the upper gastrointestinal tract.
Gastroenterology.
1988;
94
204-216
-
3
Schwartz G F, Polsky H S.
Ingested foreign bodies of the gastrointestinal tract.
Am Surg.
1976;
42
236-238
-
4
Berggreen P J, Harrison E, Sanowski R A. et al .
Techniques and complications of esophageal foreign body extraction in children and adults.
Gastrointest Endosc.
1993;
39
626-630
-
5
Neustater B, Barkin M S.
Extraction of an esophageal food impaction with a Roth retrieval net.
Gastrointest Endosc.
1996;
43
66-67
-
6
Werth R W, Edwards C, Jennings W C.
A safe and quick method for endoscopic retrieval of multiple gastric foreign bodies using a protective sheath.
Surg Gynecol Obstet.
1990;
171
419-420
-
7
Saeed Z A, Michaletz P A, Feiner S D. et al .
A new endoscopic method for managing food impaction in the esophagus.
Endoscopy.
1990;
22
226-229
-
8
Pezzi J S, Shiau Y F.
A method for removing meat impactions from the esophagus.
Gastrointest Endosc.
1994;
40
634-636
-
9
Bertoni G, Sassatelli R, Conigliano R.
A simple latex protector hood for safe endoscopic removal of sharp-pointed gastroesophageal foreign bodies.
Gastrointest Endosc.
1996;
44
458-461
-
10
Kao L S, Nguyen T, Dominitz J. et al .
Modification of a latex glove for the safe endoscopic removal of a sharp gastric foreign body.
Gastrointest Endosc.
2000;
52
127-129
-
11
Nijhawan S, Shimpi L, Jain N K, Rai R R.
Impacted foreign body at the pharyngoesophageal junction: an innovative management.
Endoscopy.
2002;
34
353
-
12
Vizcarrondo F J, Brady P G, Nord H J.
Foreign bodies of the upper gastrointestinal tract.
Gastrointest Endosc.
1983;
29
208-210
-
13
Moral L Y, Morante A JL, Lorente J LM. et al .
Terapeutica fibroendoscopica de los cuerpos extraños intraesofagicos.
Rev Esp Enferm Dig.
1992;
81
95-98
-
14
Blair S R, Graeber G M, Cruzzavala J L. et al .
Current management of esophageal impactions.
Chest.
1993;
104
1205-1208
-
15
Roura J, Morello A, Comas J. et al .
Esophageal foreign bodies in adults.
J Otorhinolaryngol.
1990;
52
51-56
-
16
Watanabe K, Kikuchi T, Katori Y. et al .
The usefulness of computed tomography in the diagnosis of impacted fish bones in the oesophagus.
J Laryngol Otol.
1998;
112
360-364
-
17
Gonzales J H, Vidal J M, Sarandeses A G. et al .
Esophageal foreign bodies in adults.
Otolaryngol Head Neck Surg.
1991;
105
649-654
-
18
Bendig D W, Mackie G G.
Management of smooth-blunt gastric foreign bodies in asymptomatic patients.
Clin Pediatr.
1990;
29
642-645
-
19
Selivanov V, Sheldon G F, Cello J P, Crass R A.
Management of foreign body ingestion.
Ann Surg.
1984;
199
187-191
-
20
Ginsberg G G.
Management of ingested foreign objects and food bolus impactions.
Gastrointest.
Endosc1995;
41
33-38
-
21
Litovitz T L, Schmitz B F.
Ingestions of cylindrical and button batteries: an analysis of 2382 cases.
Pediatrics.
1992;
89
747-757
-
22 Chaves D M, Ishioka S, Dantonio S. Corpos estranhos de esofago. In: Sakai P, Ishioka S, Maluf Filho F (eds.) Tratado de endoscopia digestiva: diagnostico e terapeutica. São Paulo; Atheneu 2000: 181-191
-
23
Singh B, Kantu M, Har-El G. et al .
Complications associated with 327 foreign bodies of the pharynx, larynx, and esophagus.
Ann Otol Laryngol.
1997;
106
301-304
-
24
Hawkins D B.
Removal of blunt foreign bodies from the esophagus.
Ann Otol Rhinol Laryngol.
1990;
99
935-940
-
25
Macpherson R I, Hill J G, Othersen H B.
Esophageal foreign bodies in children: diagnosis, treatment, and complications.
AJR Am J Roentgenol.
1996;
166
919-924
-
26
Scher R L, Tegtmeyer C J, McLean W C.
Vascular injury following foreign body perforation of the esophagus: review of the literature and report of a case.
Ann Otol Rhinol Laryngol.
1990;
99
698-702
-
27
Yamada T, Sato H, Seki M. et al .
Successful salvage of aortoesophageal fistula caused by a fish bone.
Ann Thorac Surg.
1996;
61
1843-1845
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