Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline
10 February 2016 (eFirst)
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal tract in adults.
1 ESGE recommends diagnostic evaluation based on the patient’s history and symptoms. ESGE recommends a physical examination focused on the patient’s general condition and to assess signs of any complications (strong recommendation, low quality evidence).
2 ESGE does not recommend radiological evaluation for patients with nonbony food bolus impaction without complications. We recommend plain radiography to assess the presence, location, size, configuration, and number of ingested foreign bodies if ingestion of radiopaque objects is suspected or type of object is unknown (strong recommendation, low quality evidence).
3 ESGE recommends computed tomography (CT) scan in all patients with suspected perforation or other complication that may require surgery (strong recommendation, low quality evidence).
4 ESGE does not recommend barium swallow, because of the risk of aspiration and worsening of the endoscopic visualization (strong recommendation, low quality evidence).
5 ESGE recommends clinical observation without the need for endoscopic removal for management of asymptomatic patients with ingestion of blunt and small objects (except batteries and magnets). If feasible, outpatient management is appropriate (strong recommendation, low quality evidence).
6 ESGE recommends close observation in asymptomatic individuals who have concealed packets of drugs by swallowing (“body packing”). We recommend against endoscopic retrieval. We recommend surgical referral in cases of suspected packet rupture, failure of packets to progress, or intestinal obstruction (strong recommendation, low quality evidence).
7 ESGE recommends emergent (preferably within 2 hours, but at the latest within 6 hours) therapeutic esophagogastroduodenoscopy for foreign bodies inducing complete esophageal obstruction, and for sharp-pointed objects or batteries in the esophagus. We recommend urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for other esophageal foreign bodies without complete obstruction (strong recommendation, low quality evidence).
8 ESGE suggests treatment of food bolus impaction in the esophagus by gently pushing the bolus into the stomach. If this procedure is not successful, retrieval should be considered (weak recommendation, low quality evidence).
The effectiveness of medical treatment of esophageal food bolus impaction is debated. It is therefore recommended, that medical treatment should not delay endoscopy (strong recommendation, low quality evidence).
9 In cases of food bolus impaction, ESGE recommends a diagnostic work-up for potential underlying disease, including histological evaluation, in addition to therapeutic endoscopy (strong recommendation, low quality evidence).
10 ESGE recommends urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for foreign bodies in the stomach such as sharp-pointed objects, magnets, batteries and large/long objects. We suggest nonurgent (within 72 hours) therapeutic esophagogastroduodenoscopy for medium-sized blunt foreign bodies in the stomach (strong recommendation, low quality evidence).
11 ESGE recommends the use of a protective device in order to avoid esophagogastric/pharyngeal damage and aspiration during endoscopic extraction of sharp-pointed foreign bodies. Endotracheal intubation should be considered in the case of high risk of aspiration (strong recommendation, low quality evidence).
12 ESGE suggests the use of suitable extraction devices according to the type and location of the ingested foreign body (weak recommendation, low quality evidence).
13 After successful and uncomplicated endoscopic removal of ingested foreign bodies, ESGE suggests that the patient may be discharged. If foreign bodies are not or cannot be removed, a case-by-case approach depending on the size and type of the foreign body is suggested (weak recommendation, low quality evidence).
- 1 Ambe P, Weber SA, Schauer M et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int 2012; 109: 869-875
- 2 ASGE Standards of Practice Committee. Ikenberry SO, Kue TL, Andersen MA et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011; 73: 1085-1091
- 3 Dray X, Cattan P. Foreign bodies and caustic lesions. Best Pract Res Clin Gastroenterol 2013; 27: 679-689
- 4 Ko HH, Enns R. Review of food bolus management. Can J Gastroenterol 2008; 22: 805-808
- 5 Pfau PR. Removal and management of esophageal foreign bodies. Tech Gastrointest Endosc 2014; 16: 32-39
- 6 Sugawa C, Ono J, Taleb M et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A review. World J Gastrointest Endosc 2014; 6: 475-481
- 7 Telford JJ. Management of ingested foreign bodies. Can J Gastroenterol 2005; 19: 599-601
- 8 Kramer RE, Lerner DG, Lin T et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60: 562-574
- 9 Longstreth GF, Longstreth KJ, Yao JF. Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc 2001; 53: 193-198
- 10 Ciriza C, García L, Suárez P et al. What predictive parameters best indicate the need for emergent gastrointestinal endoscopy after foreign body ingestion?. J Clin Gastroenterol 2000; 31: 23-28
- 11 Chiu YH, Hou SK, Chen SC et al. Diagnosis and endoscopic management of upper gastrointestinal foreign bodies. Am J Med Sci 2012; 343: 192-195
- 12 Conway WC, Sugawa C, Ono H et al. Upper GI foreign body: an adult urban emergency hospital experience. Surg Endosc 2007; 21: 455-460
- 13 Erbil B, Karaca MA, Aslaner MA et al. Emergency admissions due to swallowed foreign bodies in adults. World J Gastroenterol 2013; 19: 6447-6452
- 14 Wu WT, Chiu CT, Kuo CJ et al. Endoscopic management of suspected esophageal foreign body in adults. Dis Esophagus 2011; 24: 131-137
- 15 Zhang S, Cui Y, Gong X et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract in South China: a retrospective study of 561 cases. Dig Dis Sci 2010; 55: 1305-1312
- 16 Lee JH, Kim HC, Yang DM et al. What is the role of plain radiography in patients with foreign bodies in the gastrointestinal tract?. Clin Imaging 2012; 36: 447-454
- 17 Liew CJ, Poh AC, Tan TY. Finding nemo: imaging findings, pitfalls, and complications of ingested fish bones in the alimentary canal. Emerg Radiol 2013; 20: 311-322
- 18 Marco De Lucas E, Sádaba P, Lastra García-Barón P et al. Value of helical computed tomography in the management of upper esophageal foreign bodies. Acta Radiol 2004; 45: 369-374
- 19 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: 692-696
- 20 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: 426-433
- 21 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: 632-635
- 22 Goh BK, Tan YM, Lin SE et al. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol 2006; 187: 710-714
- 23 Ngan JH, Fok PJ, Lai EC et al. A prospective study on fish bone ingestion: experience of 358 patients. Ann Surg 1989; 211: 459-462
- 24 Young CA, Menias CO, Bhalla S et al. CT features of esophageal emergencies. Radiographics 2008; 28: 1541-1553
- 25 Chen T, Wu HF, Shi Q et al. Endoscopic management of impacted esophageal foreign bodies. Dis Esophagus 2013; 26: 799-806
- 26 Goh BK, Chow PK, Quah HM et al. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg 2006; 30: 372-377
- 27 Bisharat M, O’Donnell ME, Gibson N et al. Foreign body ingestion in prisoners – the Belfast experience. Ulster Med J 2008; 77: 110-114
- 28 Loh KS, Tan LK, Smith JD et al. Complications of foreign bodies in the esophagus. Otolaryngol Head Neck Surg 2000; 123: 613-616
- 29 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: 485-492
- 30 Kerlin P, Jones D, Remedios M et al. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol 2007; 41: 356-361
- 31 Vicari JJ, Johanson JF, Frakes JT. Outcomes of acute esophageal food impaction: success of the push technique. Gastrointest Endosc 2001; 53: 178-181
- 32 Al-Haddad M, Ward EM, Scolapio JS et al. Glucagon for the relief of esophageal food impaction does it really work?. Dig Dis Sci 2006; 51: 1930-1933
- 33 Leopard D, Fishpool S, Winter S. The management of oesophageal soft food bolus obstruction: a systematic review. Ann R Coll Surg Engl 2011; 93: 441-444
- 34 Sodeman TC, Harewood GC, Baron TH. Assessment of the predictors of response to glucagon in the setting of acute esophageal food bolus impaction. Dysphagia 2004; 19: 18-21
- 35 Dellon ES, Gonsalves N, Hirano I et al. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013; 108: 679-692
- 36 Waidmann O, Finkelmeier F, Welker MW et al. Endoscopic findings in patients with eosinophilic esophagitis. Z Gastroenterol 2015; 53: 379-384
- 37 Enns R, Kazemi P, Chung W et al. Eosinophilic esophagitis: Clinical features, endoscopic findings and response to treatment. Can J Gastroenterol 2010; 24: 547-551
- 38 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: 1339-1342
- 39 Emara M, Darwiesh EM, Refaey MM et al. Endoscopic removal of foreign bodies from the upper gastrointestinal tract: 5-year experience. Clin Exp Gastroenterol 2014; 7: 249-253