Diagnosis and treatment of esophageal foreign body: Operation or endoscopy?_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUE Menghua ¹ , WANG Juan ² , QI Jie ³ , ZHU Yifang ¹ , WANG Wuping ¹ , JIANG Tao ¹ ,  LU Qiang ¹

1. Department of Thoracic Surgery, The Second Hospital (Tangdu Hospital), Air Force Military Medical University, Xi'an, 710038, P. R. China;
2. Department of Clinical Laboratory Medicine, The First Hospital (Xijing Hospital), Air Force Military Medical University, Xi'an, 710032, P. R. China;
3. Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, 710068, P. R. China;

Corresponding author：

LU Qiang, Email: luqianglu@126.com

Keywords：

Esophageal foreign body; endoscope; surgery; ultra-fine gastroscope

DOI：

10.7507/1007-4848.202101106

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Objective To summarize our experience in the treatment of esophageal foreign bodies.Methods A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years.Results There were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157).Conclusion The sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.

Citation： XUE Menghua, WANG Juan, QI Jie, ZHU Yifang, WANG Wuping, JIANG Tao, LU Qiang. Diagnosis and treatment of esophageal foreign body: Operation or endoscopy?. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 206-210. doi: 10.7507/1007-4848.202101106 Copy

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2.	Bekkerman M, Sachdev AH, Andrade J, et al. Endoscopic management of foreign bodies in the gastrointestinal tract: A review of the literature. Gastroenterol Res Pract, 2016, 2016: 8520767.
3.	Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 2016, 48(5): 489-496.
4.	Aiolfi A, Ferrari D, Riva CG, et al. Esophageal foreign bodies in adults: Systematic review of the literature. Scand J Gastroenterol, 2018, 53(10-11): 1171-1178.
5.	Palta R, Sahota A, Bemarki A, et al. Foreign-body ingestion: Characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc, 2009, 69(3 Pt 1): 426-433.
6.	Evans DC, Wojda TR, Jones CD, et al. Intentional ingestions of foreign objects among prisoners: A review. World J Gastrointest Endosc, 2015, 7(3): 162-168.
7.	Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int, 2012, 109(50): 869-875.
8.	Yuan F, Tang X, Gong W, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China. Exp Ther Med, 2018, 15(2): 1257-1262.
9.	Lai AT, Chow TL, Lee DT, et al. Risk factors predicting the development of complications after foreign body ingestion. Br J Surg, 2003, 90(12): 1531-1535.
10.	Ntuli Y, Bough I, Wilson M. Recognising eosinophilic oesophagitis as a cause of food bolus obstruction. Frontline Gastroenterol, 2020, 11(1): 11-15.
11.	Loh KS, Tan LK, Smith JD, et al. Complications of foreign bodies in the esophagus. Otolaryngol Head Neck Surg, 2000, 123(5): 613-616.
12.	Park JH, Park CH, Park JH, et al. Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol, 2004, 43(4): 226-233.
13.	Søreide JA, Viste A. Esophageal perforation: Diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med, 2011, 19: 66.
14.	Chirica M, Kelly MD, Siboni S, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg, 2019, 14: 26.
15.	Ma J, Kang DK, Bae JI, et al. Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus. AJR Am J Roentgenol, 2013, 201(5): W707-W711.
16.	Mosca S, Manes G, Martino R, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: Report on a series of 414 adult patients. Endoscopy, 2001, 33(8): 692-696.
17.	Nation J, Jiang W. The utility of a handheld metal detector in detection and localization of pediatric metallic foreign body ingestion. Int J Pediatr Otorhinolaryngol, 2017, 92: 1-6.
18.	Yan XE, Zhou LY, Lin SR, et al. Therapeutic effect of esophageal foreign body extraction management: Flexible versus rigid endoscopy in 216 adults of Beijing. Med Sci Monit, 2014, 20: 2054-2060.
19.	Sung SH, Jeon SW, Son HS, et al. Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis, 2011, 43(8): 632-635.
20.	Li ZS, Sun ZX, Zou DW, et al. Endoscopic management of foreign bodies in the upper-GI tract: Experience with 1088 cases in China. Gastrointest Endosc, 2006, 64(4): 485-492.
21.	Katsinelos P, Kountouras J, Paroutoglou G, et al. Endoscopic techniques and management of foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: A retrospective analysis of 139 cases. J Clin Gastroenterol, 2006, 40(9): 784-789.
22.	Geng C, Li X, Luo R, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A retrospective study of 1294 cases. Scand J Gastroenterol, 2017, 52(11): 1286-1291.
23.	Park YK, Kim KO, Yang JH, et al. Factors associated with development of complications after endoscopic foreign body removal. Saudi J Gastroenterol, 2013, 19(5): 230-234.
24.	Cha MH, Sandooja R, Khalid S, et al. Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review. World J Gastrointest Endosc, 2021, 13(2): 45-55.

1. Hsieh A, Hsiehchen D, Layne S, et al. Trends and clinical features of intentional and accidental adult foreign body ingestions in the United States, 2000 to 2017. Gastrointest Endosc, 2020, 91(2): 350-357.
2. Bekkerman M, Sachdev AH, Andrade J, et al. Endoscopic management of foreign bodies in the gastrointestinal tract: A review of the literature. Gastroenterol Res Pract, 2016, 2016: 8520767.
3. Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy, 2016, 48(5): 489-496.
4. Aiolfi A, Ferrari D, Riva CG, et al. Esophageal foreign bodies in adults: Systematic review of the literature. Scand J Gastroenterol, 2018, 53(10-11): 1171-1178.
5. Palta R, Sahota A, Bemarki A, et al. Foreign-body ingestion: Characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc, 2009, 69(3 Pt 1): 426-433.
6. Evans DC, Wojda TR, Jones CD, et al. Intentional ingestions of foreign objects among prisoners: A review. World J Gastrointest Endosc, 2015, 7(3): 162-168.
7. Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int, 2012, 109(50): 869-875.
8. Yuan F, Tang X, Gong W, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China. Exp Ther Med, 2018, 15(2): 1257-1262.
9. Lai AT, Chow TL, Lee DT, et al. Risk factors predicting the development of complications after foreign body ingestion. Br J Surg, 2003, 90(12): 1531-1535.
10. Ntuli Y, Bough I, Wilson M. Recognising eosinophilic oesophagitis as a cause of food bolus obstruction. Frontline Gastroenterol, 2020, 11(1): 11-15.
11. Loh KS, Tan LK, Smith JD, et al. Complications of foreign bodies in the esophagus. Otolaryngol Head Neck Surg, 2000, 123(5): 613-616.
12. Park JH, Park CH, Park JH, et al. Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol, 2004, 43(4): 226-233.
13. Søreide JA, Viste A. Esophageal perforation: Diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med, 2011, 19: 66.
14. Chirica M, Kelly MD, Siboni S, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg, 2019, 14: 26.
15. Ma J, Kang DK, Bae JI, et al. Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus. AJR Am J Roentgenol, 2013, 201(5): W707-W711.
16. Mosca S, Manes G, Martino R, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: Report on a series of 414 adult patients. Endoscopy, 2001, 33(8): 692-696.
17. Nation J, Jiang W. The utility of a handheld metal detector in detection and localization of pediatric metallic foreign body ingestion. Int J Pediatr Otorhinolaryngol, 2017, 92: 1-6.
18. Yan XE, Zhou LY, Lin SR, et al. Therapeutic effect of esophageal foreign body extraction management: Flexible versus rigid endoscopy in 216 adults of Beijing. Med Sci Monit, 2014, 20: 2054-2060.
19. Sung SH, Jeon SW, Son HS, et al. Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis, 2011, 43(8): 632-635.
20. Li ZS, Sun ZX, Zou DW, et al. Endoscopic management of foreign bodies in the upper-GI tract: Experience with 1088 cases in China. Gastrointest Endosc, 2006, 64(4): 485-492.
21. Katsinelos P, Kountouras J, Paroutoglou G, et al. Endoscopic techniques and management of foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: A retrospective analysis of 139 cases. J Clin Gastroenterol, 2006, 40(9): 784-789.
22. Geng C, Li X, Luo R, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A retrospective study of 1294 cases. Scand J Gastroenterol, 2017, 52(11): 1286-1291.
23. Park YK, Kim KO, Yang JH, et al. Factors associated with development of complications after endoscopic foreign body removal. Saudi J Gastroenterol, 2013, 19(5): 230-234.
24. Cha MH, Sandooja R, Khalid S, et al. Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review. World J Gastrointest Endosc, 2021, 13(2): 45-55.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and treatment of esophageal foreign body: Operation or endoscopy?

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