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DOI: 10.1055/s-2004-825856
Removal of a Foreign Body from the Upper Gastrointestinal Tract with a Flexible Endoscope: a Prospective Study
Publication History
Submitted 25 November 2003
Accepted after Revision 20 June 2004
Publication Date:
28 September 2004 (online)

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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