Efficacy and safety of endoscopic cap in the treatment of esophageal foreign bodies: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MIN Weirun ^1,2 , HONG Ziqiang ² , CUI Baiqiang ² , JIN Dacheng ² ,  DONG Xinchun ² ,  GOU Yunjiu ²

1. First Clinical Medical school, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. First Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

DONG Xinchun, Email: 3050319523@qq.com; GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Esophageal foreign body; transparent cap-assisted endoscopy; endoscopic therapy; system assessment/metric analysis

DOI：

10.7507/1007-4848.202301016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy and safety of cap-assisted endoscopy in the treatment of esophageal foreign bodies.Methods PubMed, Web of science, The Cochrane Library, EMbase, CNKI and Wanfang were searched by computer for relevant literatures on CAP-assisted endoscopic treatment of esophageal foreign bodies from establishment to November 2022. Data were processed using RevMan 5.4.1. Results Finally, 27 studies were included, including 17 randomized controlled trials, 2 Cohort studies and 8 case-control studies, with a total of 3 619 patients. Meta-analysis results showed that compared with traditional endoscopic treatment, the success rate of removal of esophageal foreign bodies in CAP-assisted endoscopy group was higher (OR=14.43, 95%CI 10.64 to 19.55, P<0.000 01), postoperative complications were fewer (OR=0.30,95%CI 0.23 to 0.38, P<0.000 01), patients had better tolerance (OR=4.07, 95%CI 2.95 to 5.60, P<0.000 01), intraoperative visual field clarity was better (OR=12.00, 95%CI 7.29 to 19.76, P<0.000 01) and operative time was shorter (SMD=−1.83, 95%CI −2.31 to −1.34, P<0.000 01). Conclusion CAP-assisted endoscopic treatment of esophageal foreign bodies is an effective and safe method, worthy of further promotion and application in clinical practice.

1.	ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc, 2011, 73(6): 1085-1091.
2.	Monnier P. Acute food bolus impaction in the esophagus. Eur Arch Otorhinolaryngol, 2005, 262(7): 523.
3.	Lacy PD, Donnelly MJ, McGrath JP, et al. Acute food bolus impaction: Aetiology and management. J Laryngol Otol, 1997, 111(12): 1158-1161.
4.	Dray X, Cattan P. Foreign bodies and caustic lesions. Best Pract Res Clin Gastroenterol, 2013, 27(5): 679-689.
5.	王超, 戴天阳, 杨晓燕, 等. 外科途径治疗经保守处理无效的食管异物. 中国胸心血管外科临床杂志, 2018, 25(6): 539-542.
6.	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.
7.	赵刚, 杨龙宝, 董蕾, 等. 透明帽辅助内镜下食管异物治疗术的疗效分析. 中国内镜杂志, 2017, 23(7): 26-29.
8.	冯颖勋, 翟建欣. 透明帽辅助无痛胃镜下食管异物取出术的疗效评价. 中国实用医刊, 2022, 49(7): 51-54.
9.	韩娅玲. 透明帽辅助胃镜治疗食管狭窄部尖锐异物的临床价值. 中国社区医师, 2021, 37(17): 21-22.
10.	刘鸿儒, 吴锋, 尚国印. 电子胃镜加用透明帽对食管异物取出手术的辅助效果分析. 临床和实验医学杂志, 2021, 20(1): 96-100.
11.	杨艳琼. 探讨透明帽辅助上消化道异物取出术在取出食管异物中的应用. 中国保健营养, 2020, 30(14): 349.
12.	蒲蕙. 透明帽辅助胃镜异物取出术治疗食管入口异物的疗效观察. 基层医学论坛, 2020, 24(28): 4049-4050.
13.	张令. 透明帽辅助下胃镜食道异物取出术的临床效果及安全性观察. 中国初级卫生保健, 2020, 34(6): 109-111.
14.	柴建中, 高谢琼. 透明帽辅助内镜下食管异物取出术与传统内镜下异物取出术的效果比较. 临床医学研究与实践, 2019, 4(2): 51-52.
15.	屈伟明, 陈维顺, 郭有玲, 等. 透明帽辅助胃镜治疗食管狭窄部尖锐异物疗效分析. 中国医师杂志, 2019, 21(2): 284-286.
16.	洪谷俞. 透明帽辅助下取食管异物的优点. 医学信息, 2019, 32(z1): 125.
17.	孙敏. 普通电子胃镜与透明帽辅助电子胃镜对食管异物取出情况的影响. 临床医药文献电子杂志, 2019, 6(47): 59-60.
18.	李佩武, 龚伟, 高俊泽, 等. 电子胃镜加用不同型号透明帽在食管异物取出术的效果研究. 现代消化及介入诊疗, 2019, 24(6): 638-642.
19.	Fang R, Cao B, Zhang Q, et al. The role of a transparent cap in the endoscopic removal of foreign bodies in the esophagus: A propensity score-matched analysis. J Dig Dis, 2020, 21(1): 20-28.
20.	Wang Y, Chen W. Role of endoscopic transparent cap in managing pediatric foreign bodies in the entrance of the esophagus in a waking state. J Thorac Dis, 2019, 11(10): 4357-4363.
21.	Wahba M, Habib G, Mazny AE, et al. Cap-assisted technique versus conventional methods for esophageal food bolus extraction: A comparative study. Clin Endosc, 2019, 52(5): 458-463.
22.	Ooi M, Young EJ, Nguyen NQ. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus. Gastrointest Endosc, 2018, 87(5): 1198-1203.
23.	张坤峰, 雷平光, 崔毅. 内镜下透明帽辅助处理食管上段异物的前瞻性研究. 山西医药杂志, 2017, 46(12): 1412-1414.
24.	李韶华, 谢华红, 柯小茹, 等. 普通电子胃镜与透明帽辅助电子胃镜对食管异物取出情况的影响. 解放军医药杂志, 2017, 29(9): 96-98.
25.	张妍, 韩真, 袁鹤鸣. 透明帽辅助胃镜食道异物取出术的临床应用评价. 皖南医学院学报, 2017, 36(3): 234-236.
26.	左海军, 江堤, 虞晓群, 等. 食管尖锐异物取出过程中透明帽的应用效果和经验. 岭南现代临床外科, 2017, 17(6): 705-708,713.
27.	韩文, 郑军, 郝婷婷, 等. 透明帽辅助在食管入口枣核异物取出术中的临床应用价值. 广西医学, 2017, 39(8): 1251-1253.
28.	武阿丽, 张亚飞, 吴兵, 等. 透明帽在食管枣核异物取出术中的应用价值. 中国内镜杂志, 2016, 22(4): 54-57.
29.	文政伟, 雷平光, 晏洁影, 等. 透明帽辅助胃镜异物取出术在食管入口异物取出的应用. 中国临床研究, 2015, 28(6): 764-766.
30.	Zhang S, Wang J, Wang J, et al. Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: A randomized, controlled trial. J Gastroenterol Hepatol, 2013, 28(8): 1339-1342.
31.	杨根源, 郭晓红, 龚飞跃, 等. 内镜头端透明帽辅助食管上段异物治疗的对照研究. 胃肠病学和肝病学杂志, 2013, 22(7): 645-647.
32.	Ooi M, Duong T, Holman R, et al. Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: Results of a multicenter randomized controlled trial. Am J Gastroenterol, 2021, 116(11): 2235-2240.
33.	张印, 徐显林, 李海军, 等. 透明帽在胃镜下处理食管入口细小异物的作用探讨. 现代诊断与治疗, 2017, 28(6): 998-999.
34.	李茜, 苟康, 杜翔. 透明帽辅助内镜下取出食管异物疗效的Meta分析. 中国内镜杂志, 2018, 24(12): 77-82.
35.	Mohan BP, Bapaye J, Hamaad Rahman S, et al. Cap-assisted endoscopic treatment of esophageal food bolus impaction and/or foreign body ingestion: A systematic review and meta-analysis. Ann Gastroenterol, 2022, 35(6): 584-591.
36.	Tharani S, Desai M, Siddique H, et al. Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: Systematic review and meta- analysis. Gastrointest Endosc, 2022, 95(6S): AB96.
37.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
38.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
39.	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.
40.	Hasan-Mohammad Naymul, Makhsudul Alam-Md, Chandra Das-Sukanta, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Single-Centre Experience: 2796. American Journal of Gastroenterology, 2018, 113(Supplement).
41.	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.
42.	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.
43.	Lin JH, Fang J, Wang D, et al. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis, 2016, 17(2): 65-78.
44.	Tang Xiaowei, Wei Gong, Bo Jiang. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: An Analysis of 846 Cases in China: 1903[J]. American Journal of Gastroenterology, 2014, 109.
45.	刘素芹, 刘冰熔. 透明帽在消化内镜诊疗中的应用进展. 胃肠病学和肝病学杂志, 2014, 23(2): 121-123.
46.	Shidong Chu, Ci Jun, Fang Ying, et al. Removing esophageal and laryngeal foreign bodies with rigid video endoscopy: a retrospective review of 177 cases[J]. China Journal of Endoscopy, 2017, 100-102.
47.	Gang Zhao, Yang Longbao, Dong Lei, et al. Effect of transparent cap-assisted endoscopic esophageal foreign body removal[J]. China Journal of Endoscopy, 2017, 26-29.
48.	Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int, 2012, 109(50): 869-875.
49.	Wu WT, Chiu CT, Kuo CJ, et al. Endoscopic management of suspected esophageal foreign body in adults. Dis Esophagus, 2011, 24(3): 131-137.
50.	Ahmed Z, Arif SF, Ong SL, et al. Cap-Assisted Endoscopic Esophageal Foreign Body Removal Is Safe and Efficacious Compared to Conventional Methods. Dig Dis Sci, 2023, 68(4): 1411-1425.
51.	MitroviÄ-Slobodan M. , A Karan-SaÅ, Jelena VuÄ-KoviÄ-Karan, et al. Oesophageal food bolus impaction in elderly people[J]. Medicinski pregled, 2014, 67(1-2).
52.	廖虎, 刘伦旭. 成人食管异物阻塞的诊断与治疗. 中国胸心血管外科临床杂志, 2019, 26(4): 404-407.
53.	苟云久, 马继龙, 韩松辰, 等. 硬质食管镜和电子胃镜取出食管异物临床疗效的对照研究. 中国胸心血管外科临床杂志, 2019, 26(12): 1180-1184.
54.	Lin JH, Fang J, Wang D, et al. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis, 2016, 17(2): 65-78.
55.	薛孟华, 王娟, 祁杰, 等. 食管异物诊治: 手术或者内镜? 中国胸心血管外科临床杂志, 2022, 29(2): 206-210.

1. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc, 2011, 73(6): 1085-1091.
2. Monnier P. Acute food bolus impaction in the esophagus. Eur Arch Otorhinolaryngol, 2005, 262(7): 523.
3. Lacy PD, Donnelly MJ, McGrath JP, et al. Acute food bolus impaction: Aetiology and management. J Laryngol Otol, 1997, 111(12): 1158-1161.
4. Dray X, Cattan P. Foreign bodies and caustic lesions. Best Pract Res Clin Gastroenterol, 2013, 27(5): 679-689.
5. 王超, 戴天阳, 杨晓燕, 等. 外科途径治疗经保守处理无效的食管异物. 中国胸心血管外科临床杂志, 2018, 25(6): 539-542.
6. 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.
7. 赵刚, 杨龙宝, 董蕾, 等. 透明帽辅助内镜下食管异物治疗术的疗效分析. 中国内镜杂志, 2017, 23(7): 26-29.
8. 冯颖勋, 翟建欣. 透明帽辅助无痛胃镜下食管异物取出术的疗效评价. 中国实用医刊, 2022, 49(7): 51-54.
9. 韩娅玲. 透明帽辅助胃镜治疗食管狭窄部尖锐异物的临床价值. 中国社区医师, 2021, 37(17): 21-22.
10. 刘鸿儒, 吴锋, 尚国印. 电子胃镜加用透明帽对食管异物取出手术的辅助效果分析. 临床和实验医学杂志, 2021, 20(1): 96-100.
11. 杨艳琼. 探讨透明帽辅助上消化道异物取出术在取出食管异物中的应用. 中国保健营养, 2020, 30(14): 349.
12. 蒲蕙. 透明帽辅助胃镜异物取出术治疗食管入口异物的疗效观察. 基层医学论坛, 2020, 24(28): 4049-4050.
13. 张令. 透明帽辅助下胃镜食道异物取出术的临床效果及安全性观察. 中国初级卫生保健, 2020, 34(6): 109-111.
14. 柴建中, 高谢琼. 透明帽辅助内镜下食管异物取出术与传统内镜下异物取出术的效果比较. 临床医学研究与实践, 2019, 4(2): 51-52.
15. 屈伟明, 陈维顺, 郭有玲, 等. 透明帽辅助胃镜治疗食管狭窄部尖锐异物疗效分析. 中国医师杂志, 2019, 21(2): 284-286.
16. 洪谷俞. 透明帽辅助下取食管异物的优点. 医学信息, 2019, 32(z1): 125.
17. 孙敏. 普通电子胃镜与透明帽辅助电子胃镜对食管异物取出情况的影响. 临床医药文献电子杂志, 2019, 6(47): 59-60.
18. 李佩武, 龚伟, 高俊泽, 等. 电子胃镜加用不同型号透明帽在食管异物取出术的效果研究. 现代消化及介入诊疗, 2019, 24(6): 638-642.
19. Fang R, Cao B, Zhang Q, et al. The role of a transparent cap in the endoscopic removal of foreign bodies in the esophagus: A propensity score-matched analysis. J Dig Dis, 2020, 21(1): 20-28.
20. Wang Y, Chen W. Role of endoscopic transparent cap in managing pediatric foreign bodies in the entrance of the esophagus in a waking state. J Thorac Dis, 2019, 11(10): 4357-4363.
21. Wahba M, Habib G, Mazny AE, et al. Cap-assisted technique versus conventional methods for esophageal food bolus extraction: A comparative study. Clin Endosc, 2019, 52(5): 458-463.
22. Ooi M, Young EJ, Nguyen NQ. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus. Gastrointest Endosc, 2018, 87(5): 1198-1203.
23. 张坤峰, 雷平光, 崔毅. 内镜下透明帽辅助处理食管上段异物的前瞻性研究. 山西医药杂志, 2017, 46(12): 1412-1414.
24. 李韶华, 谢华红, 柯小茹, 等. 普通电子胃镜与透明帽辅助电子胃镜对食管异物取出情况的影响. 解放军医药杂志, 2017, 29(9): 96-98.
25. 张妍, 韩真, 袁鹤鸣. 透明帽辅助胃镜食道异物取出术的临床应用评价. 皖南医学院学报, 2017, 36(3): 234-236.
26. 左海军, 江堤, 虞晓群, 等. 食管尖锐异物取出过程中透明帽的应用效果和经验. 岭南现代临床外科, 2017, 17(6): 705-708,713.
27. 韩文, 郑军, 郝婷婷, 等. 透明帽辅助在食管入口枣核异物取出术中的临床应用价值. 广西医学, 2017, 39(8): 1251-1253.
28. 武阿丽, 张亚飞, 吴兵, 等. 透明帽在食管枣核异物取出术中的应用价值. 中国内镜杂志, 2016, 22(4): 54-57.
29. 文政伟, 雷平光, 晏洁影, 等. 透明帽辅助胃镜异物取出术在食管入口异物取出的应用. 中国临床研究, 2015, 28(6): 764-766.
30. Zhang S, Wang J, Wang J, et al. Transparent cap-assisted endoscopic management of foreign bodies in the upper esophagus: A randomized, controlled trial. J Gastroenterol Hepatol, 2013, 28(8): 1339-1342.
31. 杨根源, 郭晓红, 龚飞跃, 等. 内镜头端透明帽辅助食管上段异物治疗的对照研究. 胃肠病学和肝病学杂志, 2013, 22(7): 645-647.
32. Ooi M, Duong T, Holman R, et al. Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: Results of a multicenter randomized controlled trial. Am J Gastroenterol, 2021, 116(11): 2235-2240.
33. 张印, 徐显林, 李海军, 等. 透明帽在胃镜下处理食管入口细小异物的作用探讨. 现代诊断与治疗, 2017, 28(6): 998-999.
34. 李茜, 苟康, 杜翔. 透明帽辅助内镜下取出食管异物疗效的Meta分析. 中国内镜杂志, 2018, 24(12): 77-82.
35. Mohan BP, Bapaye J, Hamaad Rahman S, et al. Cap-assisted endoscopic treatment of esophageal food bolus impaction and/or foreign body ingestion: A systematic review and meta-analysis. Ann Gastroenterol, 2022, 35(6): 584-591.
36. Tharani S, Desai M, Siddique H, et al. Comparison of cap-assisted vs conventional endoscopic technique for management of food bolus impaction in the esophagus: Systematic review and meta- analysis. Gastrointest Endosc, 2022, 95(6S): AB96.
37. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
38. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
39. 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.
40. Hasan-Mohammad Naymul, Makhsudul Alam-Md, Chandra Das-Sukanta, et al. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Single-Centre Experience: 2796. American Journal of Gastroenterology, 2018, 113(Supplement).
41. 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.
42. 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.
43. Lin JH, Fang J, Wang D, et al. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis, 2016, 17(2): 65-78.
44. Tang Xiaowei, Wei Gong, Bo Jiang. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: An Analysis of 846 Cases in China: 1903[J]. American Journal of Gastroenterology, 2014, 109.
45. 刘素芹, 刘冰熔. 透明帽在消化内镜诊疗中的应用进展. 胃肠病学和肝病学杂志, 2014, 23(2): 121-123.
46. Shidong Chu, Ci Jun, Fang Ying, et al. Removing esophageal and laryngeal foreign bodies with rigid video endoscopy: a retrospective review of 177 cases[J]. China Journal of Endoscopy, 2017, 100-102.
47. Gang Zhao, Yang Longbao, Dong Lei, et al. Effect of transparent cap-assisted endoscopic esophageal foreign body removal[J]. China Journal of Endoscopy, 2017, 26-29.
48. Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int, 2012, 109(50): 869-875.
49. Wu WT, Chiu CT, Kuo CJ, et al. Endoscopic management of suspected esophageal foreign body in adults. Dis Esophagus, 2011, 24(3): 131-137.
50. Ahmed Z, Arif SF, Ong SL, et al. Cap-Assisted Endoscopic Esophageal Foreign Body Removal Is Safe and Efficacious Compared to Conventional Methods. Dig Dis Sci, 2023, 68(4): 1411-1425.
51. MitroviÄ-Slobodan M. , A Karan-SaÅ, Jelena VuÄ-KoviÄ-Karan, et al. Oesophageal food bolus impaction in elderly people[J]. Medicinski pregled, 2014, 67(1-2).
52. 廖虎, 刘伦旭. 成人食管异物阻塞的诊断与治疗. 中国胸心血管外科临床杂志, 2019, 26(4): 404-407.
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