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Quitadamo P, Pascarella A, Gragnaniello P, Isoldi S, Bucci C, Turco R, Puoti G, Furio S, Caldore M, Di Nardo G. Esophageal food bolus impaction in pediatric age. J Pediatr Gastroenterol Nutr 2024. [PMID: 38623937 DOI: 10.1002/jpn3.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Esophageal food impaction (EFI) is the sudden onset of dysphagia that occurs when a food bolus becomes lodged in the esophagus, requiring endoscopic removal. Scientific data on the prevalence and causes of EFI in children is lacking. The aim of this study was to provide further insights into EFI episodes in children. METHODS We have prospectively enrolled all children admitted for a first episode of EFI between March 2018 and March 2023. A fluoroscopic contrast study was performed in all patients to confirm the boluses and assess their position. Boluses were extracted by esophagogastroduodenoscopies, and esophageal biopsies were routinely obtained for histologic evaluation. RESULTS Over the study period, 41 children were admitted for a first episode of food impaction. Drooling was the most commonly reported symptom. Half children experiencing a first episode of food bolus were diagnosed with EoE (20/41, 48.8%). Almost a fourth of the episodes subtended a different condition, such as esophageal anastomotic, peptic or congenital strictures, stricturing caustic esophagitis, esophageal duplication, and achalasia. In the last fourth of patients the cause of EFI was not identified and thus probably related to quick eating and inadequate chewing of food. DISCUSSION Our study represents the largest known series of pediatric patients evaluated for food bolus impaction. Our main finding is the high frequency of EoE, which accounts for a half of EFI episodes in pediatric age, especially in older children. This finding highlights the importance of obtaining esophageal biopsies after the endoscopic bolus removal in children with EFI to provide a complete diagnostic evaluation.
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Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | | | - Piergiorgio Gragnaniello
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Bucci
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rossella Turco
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanna Puoti
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Mariano Caldore
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
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Redd WD, McCallen JD, Xue Z, Kiran A, Barlowe TS, Reed CC, Eluri S, Dellon ES. Association between time from esophageal food impaction to endoscopy and adverse events. Gastrointest Endosc 2024; 99:525-536.e3. [PMID: 37951280 PMCID: PMC10954388 DOI: 10.1016/j.gie.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/20/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend emergent or urgent EGD for esophageal food impaction (EFI), but data on how time to EGD impacts the risk of adverse events remain limited. We determined whether EFI-to-EGD time was associated with adverse events. METHODS In this retrospective cohort study of patients with endoscopically confirmed EFI, adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extraesophageal (aspiration, respiratory compromise, hypotension, arrhythmia). Esophageal perforation and extraesophageal adverse events requiring intensive care unit admission were classified as serious adverse events. Baseline characteristics, event details, and procedural details were compared between patients with and without adverse events. Multivariable logistic regression was performed to assess for an association between EFI-to-EGD time and adverse events. RESULTS Of 188 patients with EFI, 22 (12%) had any adverse event and 2 (1%) had a serious adverse event. Patients with adverse events were older and more likely to have an esophageal motility disorder, to tolerate secretions at presentation, and to have a higher American Society of Anesthesiologists score. EFI-to-EGD time was similar in those with and without adverse events. On multivariable analysis, EFI-to-EGD time was not associated with adverse events (odds ratio, 1.00 [95% confidence interval, .97-1.04] for 1-hour increments; odds ratio, 1.03 [95% confidence interval, .86-1.24] for 6-hour increments). Results were similar after stratifying by eosinophilic esophagitis status and after adjusting for possible confounders. CONCLUSIONS Because the time from EFI to EGD is not associated with adverse events, emergent EGD for EFI may be unnecessary, and other considerations may determine EGD timing.
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Affiliation(s)
- Walker D. Redd
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Justin D. McCallen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Zeyun Xue
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Akshatha Kiran
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trevor S. Barlowe
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Craig C. Reed
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Swathi Eluri
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
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Philibert-Rosas S, Podolsky Rapoport I. Endoscopic Management of a Long-Duration Esophageal Food Impaction: A Case Report. Cureus 2024; 16:e58829. [PMID: 38784321 PMCID: PMC11114089 DOI: 10.7759/cureus.58829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Foreign object ingestion (FOI) is a potentially life-threatening pathology that affects all ages, from children to older adults. The classification includes true FOI and esophageal food impaction (EFI), and each presents unique challenges. Endoscopic intervention is often required to prevent complications. Flexible endoscopes are the preferred management tool, ensuring a high success rate and safety. The following text presents a case of a 48-year-old male with a 5-day undiagnosed esophageal food impaction and the approach taken.
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Rustemov D, Bilal R, Tukinov R, Nekessov A, Dzhenalaev D, Ermeshev E, Mukhamedov Z, Mustafinov D, Utebaliev R, Sakuov Z, Kaliev B. Case Report: Unique management strategy for rare case of esophageal foreign body. Front Surg 2024; 11:1370876. [PMID: 38505410 PMCID: PMC10948502 DOI: 10.3389/fsurg.2024.1370876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
Background Foreign bodies that enter the esophagus can cause serious complications that may require extensive surgical intervention, including open surgery. The treatment method depends on the location, size, configuration, and number of foreign bodies in the esophagus, but to date, the best method to remove foreign bodies from the esophagus remains uncertain. Foreign bodies which can damage the walls of esophagus varies from bones and bone fragments, to metallic objects and batteries. In this article, we present a rare case of a "fish bone" penetrating through the esophagus walls and directly punctured the aorta, forming a post-traumatic saccular pseudoaneurysm of the descending thoracic aorta, which was successfully treated with endovascular stent placement to the aorta and with endoscopic foreign body removal. Case summary We reported a case of a 16-year-old male with a 6-day history of chest pain after consuming fish. As result of immediate test in regional hospital using oral flexible esophagogastroduodenoscopy abnormalities were not reported. Due to persistence of beforementioned symptoms, a fiberoptic esophagogastroduodenoscopy was performed 3 days later, revealing a 1.5-2.0 cm long altered area with contact bleeding 33.0 cm from the incisors, but no visualization of any foreign body. Computed tomography revealed a fish bone that had completely passed through walls of the esophagus and punctured the aortic wall, forming an aneurysm. Patient was urgently hospitalized by air ambulance to our hospital for high-specialized medical intervention after 6 days. After the endovascular placement of a stent graft, the fish bone was successfully removed by endoscopic intervention. 12 months follow up showed no abnormalities. Conclusion Endoscopic removal of foreign bodies in the esophagus and extracting a foreign body after thoracic endovascular aortic stent may be a feasible option for some cases.
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Affiliation(s)
- Dastan Rustemov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Bilal
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Ruslan Tukinov
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Adilzhan Nekessov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Damir Dzhenalaev
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Erbulat Ermeshev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zarip Mukhamedov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Dulat Mustafinov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Utebaliev
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zhenis Sakuov
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Baurzhan Kaliev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
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de Benito Sanz M, Tejedor-Tejada J, Mangas-Sanjuan C, Santa EDL, Cebrian I, Talegón R, Sánchez-Ocaña R, Pérez-Pariente JM, Pérez-Miranda M, García-Alonso FJ. Double-Blind Multicenter Randomized Clinical Trial Comparing Glucagon vs Placebo in the Resolution of Alimentary Esophageal Impaction. Am J Gastroenterol 2024; 119:87-96. [PMID: 37734342 DOI: 10.14309/ajg.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to compare the effectiveness of glucagon vs placebo in resolving esophageal foreign body impaction (EFBI), as well as the length of the procedure and adverse events. METHODS This was a multicenter, randomized, double-blind trial involving consecutive patients diagnosed with alimentary EFBI. Participants were randomized to receive either 1 mg of intravenous glucagon or placebo. All patients underwent upper endoscopy, and adverse events were assessed through a protocolized telephonic interview 7 days later. RESULTS The study included 72 subjects in the glucagon group and 68 in the placebo group. The foreign body was not identified in 23.6% of subjects in the glucagon group and 20.6% of subjects in the placebo group (difference 3%, 95% confidence interval -10.7% to 16.8%, P = 0.67). The median time required to remove the foreign body was similar in both groups 4 minutes (range 2-10) in the glucagon group and 3.5 minutes (range 2-7) in the placebo group (difference 0.5 minutes, 95% confidence interval -1.3 to 2.3; P = 0.59). The most common adverse event reported in both groups was mild pharyngeal pain. DISCUSSION Glucagon is no more effective than placebo in resolving EFBI or shortening the time required to remove the foreign body (EUDRA-CT number 2019-004920-40).
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Affiliation(s)
- Marina de Benito Sanz
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Eva de la Santa
- Department of Gastroenterology, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Irene Cebrian
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Raquel Talegón
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ramón Sánchez-Ocaña
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - Manuel Pérez-Miranda
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
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Haider M, Saeed A, Zijlstra M, Wenzke K, Tommolino E. The Gastric Obstruction Due to Orbeez Beads Ingestion: A Case Report With Esophagogastroduodenoscopy Findings. Cureus 2024; 16:e51857. [PMID: 38327938 PMCID: PMC10848886 DOI: 10.7759/cureus.51857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Ingestion of non-food entities poses a critical risk, particularly in children and young adults. Mostly foreign bodies can safely pass through the gastrointestinal tract if they traverse the pylorus; however, ingestion of Orbeez beads can present as a unique challenge. Orbeez beads have the potential to absorb water and can expand in the stomach and small intestine, and can result in complications including constipation, intestinal obstruction, perforation, and peritonitis. Timely diagnosis and management are crucial to improve patient outcomes. We present a case of a 19-year-old male who ingested Orbeez beads and presented with nausea, vomiting, and abdominal pain. A non-contrast CT scan of the abdomen confirmed the foreign bodies. Fifty to seventy beads were successfully removed via esophagogastroduodenoscopy (EGD) without any complications, and the patient is currently doing well.
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Affiliation(s)
- Marjan Haider
- Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Aamir Saeed
- Internal Medicine, Merit Health Wesley Hospital, Hattiesburg, USA
| | - Michael Zijlstra
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Kevin Wenzke
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Emily Tommolino
- Gastroenterology and Hepatology, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
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Kilroe MJ, McAtee KJ, McReynolds TM. A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy. J Emerg Med 2024; 66:e27-e28. [PMID: 37867036 DOI: 10.1016/j.jemermed.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Emergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. CASE REPORT We discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.
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Affiliation(s)
- Matthew J Kilroe
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Kyle J McAtee
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Tamara M McReynolds
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
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Tiebie EG, Baerends EP, Boeije T, Frankenmolen PG, Lameijer H, van den Berg W, van Stralen KJ, Ridderikhof ML, Bredenoord AJ. Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial. BMJ 2023; 383:e077294. [PMID: 38081653 PMCID: PMC10711662 DOI: 10.1136/bmj-2023-077294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of cola in resolving complete oesophageal food bolus impaction. DESIGN Open label, multicentre, randomised controlled trial. SETTING Emergency departments of five Dutch hospitals at the secondary and tertiary level, between 22 December 2019 and 16 June 2022. PARTICIPANTS 51 adults presenting with complete oesophageal food bolus impaction, defined as a sudden inability to pass saliva after consumption of foods. Patients who ingested meat that contained bones, and patients with an American Society of Anesthesiologists (ASA) physical status classification of IV or higher were excluded. INTERVENTIONS 28 patients in the intervention group were instructed to consume 25 mL cups of cola at intervals up to a maximum total volume of 200 mL. 23 patients in the control group awaited spontaneous passage. In either group, if complete resolution of symptoms did not occur, endoscopic removal was performed following current guidelines: within 6 hours for patients with complete obstruction, and within 24 hours for partial obstruction. In case of complete resolution of symptoms, elective diagnostic endoscopy was required. MAIN OUTCOME MEASURES Improvement of oesophageal food bolus obstruction as reported by patients (ie, aggregate of complete and partial passage), and evaluation of complete passage. The secondary outcome was any intervention related adverse event. RESULTS Cola did not have a meaningful effect on the improvement of food bolus obstruction (17/28 (61%) intervention v 14/23 (61%) control; odds ratio 1.00, 95% confidence interval 0.33 to 3.1; relative risk reduction 0.0, 95% confidence interval -0.55 to 0.36; P>0.99). Complete passage was reported more often in the intervention group but this difference was not significant (12/28 (43%) intervention v 8/23 (35%) control; odds ratio 1.4 (0.45 to 4.4); relative risk reduction -0.23 (-1.5 to 0.39); P=0.58). No severe adverse events occurred. However, six (21%) patients in the intervention group experienced temporary discomfort after drinking cola. CONCLUSIONS In this study, cola consumption did not lead to a higher rate of improvement of complete oesophageal food bolus impaction. Given the lack of adverse events in the treatment group and some events of resolution after treatment, cola might be considered as a first line treatment, but should not delay any planning of endoscopic management. TRIAL REGISTRATION Netherlands Trial Register (currently International Clinical Trial Registry Platform) NL8312.
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Affiliation(s)
- E G Tiebie
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - E P Baerends
- Department of Emergency Medicine, Victoria Hospital, Wynberg, Cape Town, South Africa
| | - T Boeije
- Department of Emergency Medicine, Dijklander Hospital, Hoorn, Netherlands
| | - P G Frankenmolen
- Department of Emergency Medicine, OLVG hospital, Amsterdam, Netherlands
| | - H Lameijer
- Department of Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
| | - W van den Berg
- Department of Emergency Medicine, Rode Kruis hospital, Beverwijk, Netherlands
| | - K J van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Haarlem, Netherlands
| | - M L Ridderikhof
- Department of Emergency Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - A J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Centres, PO Box 22660, 1100 DD Amsterdam, Netherlands
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Di Mitri M, Parente G, Bisanti C, Thomas E, Cravano SM, Cordola C, Vastano M, Collautti E, Di Carmine A, Maffi M, D’Antonio S, Libri M, Gargano T, Lima M. Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children. Diagnostics (Basel) 2023; 13:3285. [PMID: 37892106 PMCID: PMC10606892 DOI: 10.3390/diagnostics13203285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI's management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. MATERIALS AND METHODS The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. RESULTS An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. CONCLUSION We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way.
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Affiliation(s)
- Marco Di Mitri
- Pediatric Surgery Department, IRCCS Sant’Orsola-Malpighi Polyclinic, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy; (G.P.); (C.B.); (E.T.); (S.M.C.); (C.C.); (M.V.); (E.C.); (A.D.C.); (M.M.); (S.D.); (M.L.); (T.G.); (M.L.)
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Zhang R, Hao J, Liu H, Gao H, Liu C. Ingestion of a row of artificial dentures in an adult: A case report and review of the literature. Medicine (Baltimore) 2023; 102:e35426. [PMID: 37832100 PMCID: PMC10578667 DOI: 10.1097/md.0000000000035426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 10/15/2023] Open
Abstract
RATIONALE Foreign body (FB) ingestion is a common clinical emergency, although in most cases, the FB can pass safely through the entire gastrointestinal tract without causing any damage. However, ingestion of large dentures is very rare and alarming, as it can threaten the intestinal mucosa and cause perforation of the gastrointestinal tract, among other complications. PATIENT CONCERNS A 64-year-old Chinese male was referred to our hospital for removal of a FB, which was a large denture. Clinical symptoms included chest and upper abdominal pain. He had no cough or dyspnea. Medical history included a recent cerebral infarction, craniocerebral surgery, and being bedridden for a long term. DIAGNOSES We initially suspected a single and smooth denture, complicated by pharyngeal and esophageal mucosal injury. Radiographic examination however showed a 70-mm long opaque object located in the middle and upper esophagus, close to the trachea and aorta. INTERVENTIONS Multiple dentures and metal hooks were removed via endoscopy using a net, grasping forceps, and rubber jacket. OUTCOMES The patient recovered well and experienced no postoperative complications. The patient was discharged 5 days after endoscopic therapy. LESSONS Our case showed that endoscopy was effective for the retrieval of an esophageal FB. For sharp FBs, the use of a net and rubber jacket is a good choice. However, we advocate for appropriate surgery in patients in whom endoscopy is not possible after an accurate diagnosis or those with severe complications.
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Affiliation(s)
- Ranran Zhang
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
- Department of Endoscopy Center, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
| | - Jiahui Hao
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
- Department of Endoscopy Center, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
| | - Haiyan Liu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
- Department of Endoscopy Center, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
| | - Hongfu Gao
- Department of Endoscopy Center, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
| | - Chengxia Liu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
- Department of Endoscopy Center, Binzhou Medical University Hospital, Binzhou, Shandong, P. R. China
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Guo H, Hamilton P, Enns E, Gupta M, Andrews CN, Nasser Y, Bredenoord AJ, Dellon ES, Ma C. Postendoscopy Care for Patients Presenting With Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study. Am J Gastroenterol 2023; 118:1787-1796. [PMID: 37410911 DOI: 10.14309/ajg.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Esophageal food bolus impactions (FBI) are a common gastrointestinal emergency. Appropriate management includes not only index endoscopy for disimpaction but also medical follow-up and treatment for the underlying esophageal pathology. We evaluated the appropriateness of postendoscopy care for patients with FBI and assessed patient-related, physician-related, and system-related factors that may contribute to loss to follow-up. METHODS We conducted a retrospective, population-based, multicenter cohort study of all adult patients undergoing endoscopy for FBI in the Calgary Health Zone, Canada, from 2016 to 2018. Appropriate postendoscopy care was defined by a composite of a clinical or endoscopic follow-up visit, appropriate investigations (e.g., manometry), or therapy (e.g., proton-pump inhibitors or endoscopic dilation). Predictors of inappropriate care were assessed using multivariable logistic regression. RESULTS A total of 519 patients underwent endoscopy for FBI: 25.2% (131/519) did not receive appropriate postendoscopy care. Half of the patients (55.3%, 287/519) underwent follow-up endoscopy or attended clinic, and among this group, 22.3% (64/287) had a change in their initial diagnosis after follow-up, including 3 new cases of esophageal cancer. Patients in whom a suspected underlying esophageal pathology was not identified at the index endoscopy were 7-fold (adjusted odds ratio 7.28, 95% confidence interval 4.49-11.78, P < 0.001) more likely to receive inappropriate postendoscopy follow-up and treatment, even after adjusting for age, sex, rural residence, timing of endoscopy, weekend presentation, and endoscopic interventions. DISCUSSION One-quarter of patients presenting with an FBI do not receive appropriate postendoscopy care. This is strongly associated with failure to identify a potential underlying pathology at index presentation.
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Affiliation(s)
- Howard Guo
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamilton
- Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edwin Enns
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Milli Gupta
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology & Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher Ma
- Department of Medicine, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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12
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Sghaier A, Mraidha MH, Jarrar MS, Gaddour M, Elghali MA, Youssef S. An unusual etiology of acute intestinal occlusion: The swallowed missing dentures a case reports and literature review. Int J Surg Case Rep 2023; 110:108770. [PMID: 37660490 PMCID: PMC10510072 DOI: 10.1016/j.ijscr.2023.108770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Denture swallowing is an uncommon incident. However, it should be suspected in edentulous elderly patients who wear removable dentures which are poorly cared for and maintain. The existence of neuro-psychiatric disorders may contribute to the occurrence of this adverse event. CASE PRESENTATION We report the case of an 85-years-old woman admitted to emergency with acute intestinal occlusion. The investigations concluded that the bowel was obstructed by a foreign body blocked in the terminal ileum. There was a high suspicion that his dental prosthesis had been swallowed. Removal of the dental prosthesis was achieved surgically after laparotomy. DISCUSSION Foreign bodies in the esophagus could be responsible of a variety of symptoms, including dysphagia, airway obstruction and even perforation. In the gastrointestinal tract foreign bodies may be responsible of fewer specific symptoms, including abdominal pain, melena or perforation. The blockage will occur in anatomical strictures. At the most appropriate situations, removal should be performed through endoscopy, although in case of failure of procedure or complication, surgery will be unavoidable. CONCLUSION Ingestion of a dental or other foreign object is a clinical condition that is more common in pediatric populations, but is very rare in healthy individuals. Denture swallowing is insidious in itself and may lead to a complicated course, if not properly managed. Although most of these can be conservative, careful monitoring is necessary to avoid such adverse event.
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Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia.
| | - Mohamed Hédi Mraidha
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
| | - Mohamed Salah Jarrar
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Departement of anatomy, Tunisia
| | - Mariem Gaddour
- Faculty of Medicine of Sousse, University of Sousse, Tunisia; Hospital of Sahloul, Tunisia; Departement of physical medicine and functional rehabilitation, Tunisia
| | - Mohamed Amine Elghali
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of general surgery, Tunisia
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13
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:238-246. [DOI: 10.13105/wjma.v11.i5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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14
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Gangwani MK, Aziz M, Dahiya DS, Aziz A, Priyanka F, Karna R, Lee-Smith W, Ahmed Z, Kamal F, Inamdar S, Alastal Y, Adler D. Comparable Efficacy for Push Versus Pull Technique in Esophageal Food Impaction: Systematic Review with Meta-Analysis. Dig Dis Sci 2023:10.1007/s10620-023-07988-0. [PMID: 37278950 DOI: 10.1007/s10620-023-07988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Esophageal food impaction (EFI) is a common GI emergency. Push and pull methods are used currently for EFI retrieval. We aim to review current available literature to compare success rates and evaluate adverse event rates of the two techniques. METHODS A comprehensive literature search was performed using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, SciELO and Global Index Medicus. Odds ratio (OR) with 95% confidence interval (CI) was calculated when comparing the dichotomous variables. We aimed to evaluate technical success and adverse events for EFI comparing push and pull technique on single arm and comparator analysis. RESULTS The search strategy yielded a total of 126 articles. 18 studies with 3528 participants were included. The technical success rate was 97.5% (CI 96.6-99.2%) in the push and 88.4% (CI 72.8-98.7%) in the pull technique with no statistical difference on comparator analysis. Overall rate of adverse events was 4.03% (CI 0.9-5.0%) in the push technique and 2.22% (CI 0-2.9%) in the pull technique with no statistical difference on comparator analysis (OR 95% CI 0.464-2.782, p = 0.78, I2 = 31.54%). There was no statistical difference between rate of lacerations and perforations either between the two techniques. CONCLUSION Both techniques have acceptable clinical outcomes which appear within standard of care. Operator experience and individual clinical scenarios should guide decision-making regarding technique selection.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Dushyant Singh Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, 48603, USA
| | - Abeer Aziz
- Department of Gastroenterology and Hepatology, Augusta University, Augusta, GA, USA
| | - Fnu Priyanka
- Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Rahul Karna
- Department of Medicine, Alleghany General Hospital, Pittsburgh, PA, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Faisal Kamal
- Digestive Health Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Yaseen Alastal
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, 43614, USA
| | - Douglas Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Center Health, Denver, CO, 80210, USA.
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15
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Macedo Silva V, Lima Capela T, Freitas M, Cúrdia Gonçalves T, Boal Carvalho P, Rosa B, Cotter J. Decision-To-Scope Score: A novel tool with excellent accuracy in predicting foreign bodies in the esophagus. J Gastroenterol Hepatol 2023; 38:970-975. [PMID: 37143176 DOI: 10.1111/jgh.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Foreign body (FB) ingestion is a common indication for urgent esophagogastroduodenoscopy (EGD). Nevertheless, most pass spontaneously through the gastrointestinal (GI) tract. Differently from GI bleeding, there is no validated score aiming to identify "low-risk" patients in suspected FB ingestion. We aimed to create a score able to discriminate patients who are candidates to emergent EGD in this scenario. METHODS Retrospective study of consecutive patients admitted for suspected FB in the upper GI tract between 2016 and 2021. The evaluated outcome was endoscopic confirmation of FB in the esophagus. Variables significantly associated with the outcome on multivariate analysis were computed into a score predicting endoscopic confirmation. RESULTS We included 228 patients. From these, 97 (42.5%) had a confirmed FB in EGD. Time since ingestion <6 h (OR = 4.0; P = 0.042), absence of any meal after FB ingestion (OR = 7.1; P = 0.005), dysphagia (OR = 11.8; P < 0.001), odynophagia (OR = 4.6; P = 0.004), and drooling (OR = 15.1; P < 0.001) were independent predictors of confirmed FB. These variables were used to compute a FB predicting score-the Decision-To-Scope (DTS) Score: time since ingestion <6 h (+1 point), absence of meals (+2 points), dysphagia (+3 points), odynophagia (+1 point), and drooling (+4 points). DTS-Score had excellent accuracy to predict the outcome (AUC = 0.953; 95%CI = 0.928-0.977; P < 0.001). The optimal cutoff to identify low-risk patients was a score ≤5 (sensitivity 85.0% and specificity 94.7%). CONCLUSIONS More than half of the suspected FB were not confirmed by EGD. The DTS-Score presented excellent accuracy at stratifying patients' risk and may contribute to the decision to perform emergent EGD in suspected FB ingestion.
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Affiliation(s)
- Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago Lima Capela
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Marta Freitas
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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16
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:38-46. [DOI: 10.13105/wjma.v11.i1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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17
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Schreiner P, Safroneeva E, Schoepfer A, Greuter T, Biedermann L, Schlag C, Labenz J, Auth MKH, Bredenoord AJ, Chang JW, Bonis PA, Rothenberg ME, Collins MH, Hirano I, Gupta SK, Katzka DA, Dellon ES, Straumann A, Furuta GT, Gonsalves N. Management of eosinophilic esophagitis associated food impaction in Europe and the United States. Dis Esophagus 2022; 35:6516224. [PMID: 35088073 DOI: 10.1093/dote/doac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is the most common cause of esophageal food impaction (EFI). Approaches to management of EFI due to EoE have not been well characterized. We conducted a web-based survey to understand approaches to management of EFI due to EoE among endoscopists. Questions focused on management of patients from presentation to post-endoscopy follow-up. The survey was administered to a list of eligible candidates provided by societies of gastroenterology. A total of 308 endoscopists completed the questionnaire. The majority (83%) practiced in Europe and treated adults (78%). Most agreed patients should be advised to seek emergency care (66%) within 1 to 2 hours (41% agreement). There was agreement that medications to induce vomiting should be avoided (84%) and that blood tests or imaging studies were usually not required before endoscopy. By contrast, there was more variability in the type of sedation recommended and the need for endotracheal intubation, especially when comparing more experienced with less experienced EoE-endoscopists. Overall, fewer than half (43%) respondents recommended obtaining esophageal biopsies during the initial endoscopy. However, there were significant differences in the proportion who recommended biopsies based on level of EoE-experience (25, 52, 77%, P < 0.001; less vs. moderate vs. very experienced) and comparing pediatric and adult endoscopists (32, vs. 79%, P < 0.001; adult vs. pediatric). There exists heterogeneity among endoscopists in recommendations to manage EFI in patients with EoE. These findings support development of clinical guidelines and new studies to clarify the rationale for best practices. Key summary: Established knowledge-The optimal management of patients with esophageal food impaction due to eosinophilic esophagitis from presentation at the emergency department to postendoscopy care is unclear. New findings-Considerable recommendation variation exists in the management of EFI in patients with EoE. Our findings provide a rationale for the creation of consensus practice guidelines and further study into best practices.
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Affiliation(s)
- Philipp Schreiner
- Department of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Schlag
- Department of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Joachim Labenz
- Department of Medicine, Diakonie Hospital Jung- Stilling, Siegen, Germany
| | - Marcus K H Auth
- Alder Hey Children's NHS Foundation Trust and University of Liverpool, Liverpool, UK
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joy W Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter A Bonis
- Division of Gastroenterology, Tufts University School of Medicine, Boston, MA, USA
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University/Community Health Network, Indianapolis, IN, USA
| | - David A Katzka
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alex Straumann
- Department of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado and Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
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18
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Valentino WL, Sharifi-Amina S. Esophageal Food Impaction. Radiol Case Rep 2022; 17:2979-2982. [PMID: 35755121 PMCID: PMC9218282 DOI: 10.1016/j.radcr.2022.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Esophageal foreign body impaction requires urgent or emergent removal depending on clinical symptoms. Radiographic evaluation is extremely valuable in guiding management, although not required. The case presented herein describes a 66-year-old male presenting with epigastric pain and globus sensation for three days, inability to tolerate both foods and liquids, and regurgitation. Fluoroscopic evaluation revealed a food impaction in the distal esophagus. Urgent endoscopy confirmed the diagnosis and revealed a peptic stricture secondary to Barrett's esophagus. Although computed tomography has largely replaced the fluoroscopic examination, it can still provide a definitive diagnosis in many cases.
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Affiliation(s)
- William L Valentino
- Riverside Community Hospital, Department of Radiology, 4445 Magnolia Ave, Riverside, CA, 92501, USA
- HCA Healthcare, Nashville, TN, USA
| | - Soheil Sharifi-Amina
- Riverside Community Hospital, Department of Radiology, 4445 Magnolia Ave, Riverside, CA, 92501, USA
- HCA Healthcare, Nashville, TN, USA
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19
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Delayed Endoscopic Management of Esophageal Sharp-Pointed Food Impaction: An Analysis of 829 Cases in China. Dig Dis Sci 2022; 67:3166-3176. [PMID: 34342753 DOI: 10.1007/s10620-021-07133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction. AIMS To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings. METHODS This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal <12 h) and delayed intervention (>12 h) cohorts. RESULTS Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P < 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P < 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction. CONCLUSIONS Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.
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20
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Chen ZC, Chen GQ, Chen XC, Zheng CY, Cao WD, Deng GH. Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta: A case report. World J Clin Cases 2022; 10:2484-2490. [PMID: 35434050 PMCID: PMC8968600 DOI: 10.12998/wjcc.v10.i8.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair (TEVAR).
CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish. No abnormal findings were observed by the emergency esophagoscopy. Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta. The patient refused to undergo surgery for personal reasons and was discharged. Five days after the onset of illness, he was readmitted to our hospital. Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus. Endoscopic ultrasonography confirmed a fishbone under the nodule. After performing TEVAR, we incised the esophageal mucosa under an endoscope and successfully removed the fishbone. The patient has remained in good condition for 1 year.
CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.
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Affiliation(s)
- Zhi-Cao Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gui-Quan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Xiao-Chun Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Chang-Ye Zheng
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Wei-Dong Cao
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gang-Hao Deng
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
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21
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Correia CJA, Almeida N, Barreto L, Figueiredo PN. The hidden dangers of
SARS‐CoV
‐2 testing …. ADVANCES IN DIGESTIVE MEDICINE 2022. [PMCID: PMC8652956 DOI: 10.1002/aid2.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half‐broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS‐CoV‐2 test.
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Affiliation(s)
- Catarina J. A. Correia
- Gastroenterology Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Nuno Almeida
- Gastroenterology Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Lagchar Barreto
- Gastroenterology Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Pedro N. Figueiredo
- Gastroenterology Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
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22
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Conthe A, Payeras Otero I, Pérez Gavín LA, Baines García A, Usón Peiron C, Villaseca Gómez C, Herrera Fajes JL, Nogales Ó. ESOPHAGEAL FISH BONE IMPACTION: THE IMPORTANCE OF EARLY DIAGNOSIS AND TREATMENT TO AVOID SEVERE COMPLICATIONS. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:660-662. [DOI: 10.17235/reed.2022.8537/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Hu T, Zhang J, Liu Y, Chen L, Cen W, Wu W, Huang Q, Sun X, Stock S, Zippi M, Zimmer V, Basharat Z, Hong W. Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases. Gastroenterol Rep (Oxf) 2022; 10:goac036. [PMID: 35966628 PMCID: PMC9366183 DOI: 10.1093/gastro/goac036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/17/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs. METHODS We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated. RESULTS In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery. CONCLUSION Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.
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Affiliation(s)
| | | | | | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wei Cen
- The First Clinical College, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wenzhi Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Qingke Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Xuecheng Sun
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Simon Stock
- Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Wandong Hong
- Corresponding author. Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325025, Zhejiang, P. R. China. Tel: +86-577-88069817; Fax: +86-577-88069555; ;
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24
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Siddique MS, Mumtaz A, Saeed MS, Bani Fawwaz BA, Hurairah A. Esophageal Foreign Body Removal: A Novel Approach. Cureus 2021; 13:e18081. [PMID: 34557374 PMCID: PMC8449713 DOI: 10.7759/cureus.18081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Upper esophageal foreign body impaction is a common clinical presentation and often requires medical attention. The most common foreign bodies encountered in the adult population are food-related, e.g., steak pieces and meat bones. Endoscopic interventions are indicated when the foreign objects fail to pass spontaneously. The standard methods to remove these foreign bodies include push technique and retrieval methods using various endoscopic instruments. However, we report a unique method that was used to remove a large upper esophageal impacted foreign body refractory to removal by standard procedures.
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Affiliation(s)
| | - Aqsa Mumtaz
- Internal Medicine, Mayo Hospital, Lahore, PAK
| | | | | | - Abu Hurairah
- Gastroenterology and Hepatology, AdventHealth Orlando, Orlando, USA
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25
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Lee WH, Grover Z, Borland M, Thacker K. Medical Disimpaction for Children With Organic Esophageal Foreign Body in the Era of Eosinophilic Esophagitis. Pediatr Emerg Care 2021; 37:e464-e467. [PMID: 30399068 DOI: 10.1097/pec.0000000000001673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine. Interventions (medical or endoscopic) are often required because of the severity of symptoms and risk of complications. Use of medical disimpaction (MD) such as glucagon injections and effervescent agents (eg, carbonated beverages) has been well described in adults; however, there are limited data in the pediatric literature. Eosinophilic esophagitis (EoE) is a relatively "new" clinicopathological entity that may present with EFBI mostly due to food with histological findings of EoE. Our study aim was to determine the efficacy of MD for organic EFBI in the pediatric population especially in children with EoE. METHODS A retrospective chart review was performed using the International Classification of Diseases codes and the emergency department database of patients presenting with EFBI from January 2010 to December 2014. Response to MD was defined as symptomatic relief of obstruction. Age, object ingested, medical agent used, EoE status, complications, and outcome were recorded. RESULTS A total of 317 presentations of EFBI were identified during the study period, of which organic EFBI accounted for 101 impactions (31.9%). Medical disimpaction was attempted for 42 (41.6%) with organic EFBI, resulting in resolution of symptoms for 16 (38.1%). One child with EoE responded to MD compared with 15 without EoE (4.8% vs 71.4%, P < 0.0001). CONCLUSIONS Medical disimpaction was ineffective in children with EoE but may be of help with symptom resolution in approximately 70% of children without EoE.
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Affiliation(s)
- Wei Hao Lee
- From the Princess Margaret Hospital for Children and Perth Children's Hospital, Perth, Australia
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26
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Gurala D, Polavarapu A, Philipose J, Amarnath S, Avula A, Idiculla PS, Demissie S, Gumaste V. Esophageal Food Impaction: A Retrospective Chart Review. Gastroenterology Res 2021; 14:173-178. [PMID: 34267832 PMCID: PMC8256903 DOI: 10.14740/gr1387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background Esophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology, with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. Patients presenting with food impaction often have underlying esophageal pathology. We evaluated the possible risk factors for EFI in our study. Methods We performed a retrospective chart review of 455 patients at Staten Island University Hospital (SIUH) that presented with symptoms of food impaction from 1999 to 2017. We analyzed relevant clinical data such as age, risk factors, type of food bolus, location, administration of glucagon, endoscopic technique and complications. Results Overall, 174 patients had endoscopically confirmed EFI. The majority were males 102/174 (58.6%). Esophageal pathological findings included esophagitis in 58/174 (33.3%), strictures in 43/174 (24.7%), hiatal hernias in 29/174 (16.6%) and Schatzki’s rings in 15/174 (8.6%). Thirty-two out of 174 (18.3%) had normal endoscopic findings. Diabetes mellitus (DM) was reported in 20/174 (11.4%) patients. The type of food impacted was mostly meat in 73/174 (41.9%) cases. The location of EFI was mainly in the lower one-third of the esophagus in 94/174 (54%). The endoscopic push technique was used in 95/174 (54.5%) patients and the pull technique in 83/174 (47.7%) cases. The endoscopic therapeutic intervention was successful as a first attempt in 165/175 (94.8%) patients. Complications were reported in only 5/174 (2.8%), and these mostly comprised of perforations and tears. Glucagon was given to 74/174 (42.5%) patients. The median door-to-scope time (time of presentation at the emergency department to endoscopic intervention) was 7 h (range 1.5 - 24 h) in patients who had received glucagon as opposed to 7 h (range 1 - 24 h) in patients who did not receive it. Conclusion EFI is more common in males. Esophageal strictures and hiatal hernias were the most common pathologies found in endoscopy. Esophagitis was evident in 33.3% of patients, but if it was the cause or consequence of EFI is not clearly understood. DM was associated with food impaction in only 11.4% of patients, but more studies are needed to determine if DM has a stronger association with EFI. The door-to-scope time was shorter in patients who had received glucagon. Endoscopy is a safe and effective therapeutic intervention for EFI, and complications reported were minimal.
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Affiliation(s)
- Dhineshreddy Gurala
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Abhishek Polavarapu
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Jobin Philipose
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Shivantha Amarnath
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Akshay Avula
- Department of Pulmonary and Critical Care, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Pretty Sara Idiculla
- Department of Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, India
| | - Seleshi Demissie
- Biostatistics Unit, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Vivek Gumaste
- Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
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27
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Wu L, Lei G, Liu Y, Wei Z, Yin Y, Li Y, Wang G. Retrospective Analysis of Esophageal Foreign Body Ingestion: Differences Among Weekday, Weekends, and Holidays. Risk Manag Healthc Policy 2021; 14:2499-2506. [PMID: 34163269 PMCID: PMC8214566 DOI: 10.2147/rmhp.s314069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/02/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose Current data on the occurrence of EFBs in relation to different time periods are scant. The purpose of this study was to compare the occurrence, type and location of EFBs in people who presented at our center on weekdays, weekends and holidays. Patients and Methods A retrospective analysis of patients (n=1353) received rigid esophagoscopy for foreign body extraction under general anesthesia from January 2018 to 2020 December. Results The occurrence of EFB ingestion was significantly higher (p<0.05) on holidays (2.75/day) than on weekdays (0.91/day) and weekends (1.46/day). Patients were much older on holidays, with a mean age of 58.18 ± 17.34 years, than patients on weekdays (54.71 ± 16.71 years) and weekends (55.05 ± 17.36 years). Conclusion Our findings demonstrate that EFB ingestion is most likely to occur on weekends and holidays, and elderly patients should be advised to chewing slowly and eating non-nuclear jujube, especially during holidays, to minimize their risk.
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Affiliation(s)
- Lili Wu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guiyu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ying Liu
- Operating Room, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zheng Wei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yue Yin
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, People's Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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28
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Hackett R, Brownson AR, Hill J, Raos Z. Management of Adults with Acute Oesophageal Soft Food Bolus and Foreign Body Obstructions at Two New Zealand District Health Boards. Clin Exp Gastroenterol 2021; 14:237-247. [PMID: 34121843 PMCID: PMC8189695 DOI: 10.2147/ceg.s300240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Aim 1. Investigate the characteristics of adult patients presenting with acute oesophageal soft food bolus obstruction (SFBO) and impacted foreign body (IFB) at two New Zealand district health boards (DHBs). 2. Review current management against international guidelines for SFBO and IFB. Methods A multicentre retrospective search of the Provation® endoscopy database identified patients presenting with acute oesophageal obstruction. Utilising electronic patient records, key data points including patient demographics, risk factors, pre-endoscopic medical therapies utilised, diagnostic radiological investigations performed and endoscopic complications were identified. Key timepoints and delays in the patient’s hospital journey from oesophageal obstruction to therapeutic endoscopy were recorded. The probability of failing to undergo therapeutic endoscopy for SFBO within the timeframes advised in clinical guidelines as a result of a delay in referral to the endoscopy service was calculated. Results Over a cumulative 10.5-year period of data collection, 227 oesophago-gastro-duodenoscopies were performed: 195 SFBO, 16 IFB, 16 no obstruction identified. Median patient age was 57 (15–95) years. 143 male and 84 female patients. Radiographs were performed in 50.9% of uncomplicated SFBO. Pre-endoscopy medical therapies were administered in 41.4% of the cases. Median time delay from onset of obstruction to therapeutic endoscopy varied: SFBO 19h 0min, complete obstruction 17h 45min, impacted batteries 1h 15min, and presumed sharp objects 6h 0min. Three patients presenting with a soft food bolus obstruction failed to undergo therapeutic endoscopy due to a delay in referral to the endoscopy service, probability 0.034 (95% CI 0.012, 0.095). Two patients died of complications secondary to oesophageal obstruction. Discussion Oesophageal obstruction is a common gastroenterological presentation. At two large centres in New Zealand, patients waited considerably longer than the recommended timeframe from obstruction to therapeutic endoscopy. Contributing factors included patient-related delays to presentation, hospital system-related factors and delays in referral for endoscopy contributed to by unnecessary pre-endoscopic medical therapies and radiographic investigations. Education about oesophageal obstruction together with robust local guidelines have potential to reduce delays and length of hospital stay, as well as reduce patient discomfort and complications.
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Affiliation(s)
- Robert Hackett
- Department of Gastroenterology, Bay of Plenty District Health Board, Tauranga, New Zealand.,Department of Medicine, University of Otago, Wellington, New Zealand
| | - Anthony R Brownson
- Department of Medicine, Southern District Health Board, Dunedin, New Zealand
| | - Jason Hill
- Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand
| | - Zoe Raos
- Department of Gastroenterology, Waitemata District Health Board, Auckland, New Zealand
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29
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Ciarambino T, Sansone G, Para O, Giordano M. Dysphagia: what we know? A minireview. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Fang Y, Qin Z. Comparison of Endoscopy Alone with Surgery Converted from Endoscopy for the Removal of Esophageal Foreign Bodies in Adults: A Retrospective Study from a Single Center. Med Sci Monit 2021; 27:e929142. [PMID: 33813590 PMCID: PMC8029154 DOI: 10.12659/msm.929142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The impaction of an esophageal foreign body is an urgent situation requiring emergency intervention. This retrospective study from a single center in China aimed to compare endoscopy alone with surgery converted from endoscopy for the removal of esophageal foreign bodies in adults. Material/Methods A total of 252 patients with esophageal foreign bodies were divided into 3 groups based on the treatment received: endoscopy, surgery converted from endoscopy, or surgery only. Patients’ clinical and demographic data were retrospectively reviewed and analyzed. Results The diameter of the foreign bodies in patients treated by surgery converted from endoscopy was larger than that of those treated by simple endoscopy (5.2 cm vs 2.7 cm, P=0.0003). The cervical or upper thoracic esophagus was the most common site of foreign body impaction treated by surgery converted from endoscopy, while the foreign bodies removed by simple endoscopy were frequently lodged at the middle thoracic esophagus (P=0.021). Bone-related foreign bodies and dentures were most likely impacted in patients treated with surgery converted from endoscopy. The factors influencing the choice of treatment included foreign body maximal diameter and location. Conclusions Larger foreign bodies that were found in the cervical or upper thoracic esophagus were associated with failed endoscopic removal and required surgical removal. Irregularly shaped or sharp foreign bodies, including dentures and fishbones, required surgical removal. These findings may guide future decisions of first-line approaches for the removal of esophageal foreign bodies.
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Affiliation(s)
- Yu Fang
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Zhiming Qin
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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31
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Mathew RP, Sarasamma S, Jose M, Toms A, Jayaram V, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1. SA J Radiol 2021; 25:2022. [PMID: 33936794 PMCID: PMC8063768 DOI: 10.4102/sajr.v25i1.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Sreekutty Sarasamma
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Merin Jose
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Ajith Toms
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vinayak Jayaram
- Department of Radiology, Faculty of Radiology, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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Cha MH, Sandooja R, Khalid S, Lao N, Lim J, Razik R. Complication rates in emergent endoscopy for foreign bodies under different sedation modalities: A large single-center retrospective review. World J Gastrointest Endosc 2021; 13:45-55. [PMID: 33623639 PMCID: PMC7890405 DOI: 10.4253/wjge.v13.i2.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/31/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Foreign object ingestion (FOI) and food bolus impaction (FBI) are common causes of emergent endoscopic intervention. The choice of sedation used is often dictated by physician experience. Many endoscopists frequently prefer to use monitored anesthesia care (MAC) and general anesthesia (GA) as opposed to conscious sedation (CS) due to the concern for inadequate airway protection. However, there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and FBI.
AIM To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities.
METHODS We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals. A standardized questionnaire was utilized to collect data on demographics, endoscopic details, sedation practices, hospital stay and adverse events. Complications recognized during and within 24 h of the procedure were considered early, whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed complications. Complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types, namely CS, MAC and GA. Chi-square analysis and multiple logistic regression were used to compare complication rate based on sedation type.
RESULTS Among the 929 procedures analyzed, 353 procedures (38.0%) were performed under CS, 278 procedures (29.9%) under MAC and the rest (32.1%) under GA. The median age of the subjects was 52 years old, with 57.4% being male. The majority of the procedures (64.3%) were FBI with the rest being FOI (35.7%). A total of 132 subjects (14.2%) had chronic comorbidities while 29.0% had psychiatric disorders. The most commonly observed early complications were mucosal laceration (3.8%) and bleeding (2.6%). The most common delayed complication was aspiration pneumonia (1.8%). A total of 20 patients (5.6%) could not adequately be sedated with CS and had to be converted to MAC or GA. Patient sedated with MAC and GA were more likely to require hospitalization, P < 0.0001. Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS (14.7%), MAC (14.7%) and GA (19.5%), P = 0.19.
CONCLUSION For patients who present with FOI or FBI and undergo emergent endoscopic treatment, there is no significant difference in adverse event rates between CS, MAC and GA.
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Affiliation(s)
- Ming-Han Cha
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Rashi Sandooja
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Saher Khalid
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Nicole Lao
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Joseph Lim
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, United States
| | - Roshan Razik
- Department of Gastroenterology, Cleveland Clinic Akron General, Akron, OH 44307, United States
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Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process. Eur Arch Otorhinolaryngol 2021; 278:3613-3623. [PMID: 33417148 DOI: 10.1007/s00405-020-06569-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. METHODS An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. RESULTS This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. CONCLUSION This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.
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Wang H, Lin DL, Wang XF, Qu YW, Wu LS, Yu P, Wang WA. Endoscopic management of foreign bodies in the gastrointestinal tract: A retrospective study of 109 cases. Shijie Huaren Xiaohua Zazhi 2020; 28:1243-1248. [DOI: 10.11569/wcjd.v28.i24.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ingestion of foreign bodies in the gastrointestinal tract is commonly encountered in clinical practice. Reports on individualized endoscopic removal of gastrointestinal foreign bodies are scarce.
AIM To explore the method of individualized endoscopic removal of indigested foreign bodies in the gastrointestinal tract to improve the success rate of foreign body endoscopic removal.
METHODS The clinical data of patients with digestive tract foreign bodies treated at the Third Medical Center of PLA General Hospital (former General Hospital of Armed Police Forces) from July 2014 to April 2019 were retrospectively analyzed.
RESULTS One hundred and nine patients were included in the study, including 46 men (42.2%) and 63 women (57.8%). Their age ranged from 11 to 88 years, with an average age of 57.3 years; 52 cases (47.7%) were elderly. The most common type of foreign body was jujube kernel (53 cases, 48.6%), followed by fish bone (24 cases, 22%) and food mass (15 cases, 13.8%). The most common location of foreign bodies in the digestive tract was the esophagus (84 cases, 76.9%), followed by the colon (7 cases, 6.4%), anastomosis (6 cases, 5.5%), stomach (5 cases, 4.5%), and duodenum (2 cases, 1.8%). Pharynx foreign bodies can be directly removed with foreign body forceps, with the shortest time taken (average, 2.5 ± 0.7 min). For esophageal foreign bodies, foreign body forceps were used to clamp one end of the foreign bodys, exert to the opposite side, make it leave the mucous membrane and parallel to the lumen, and then remove. The foreign body in the upper part of the esophagus can be added with a casing or transparent cap. The foreign body in the lower esophagus can be pushed into the stomach and then removed under the endoscope. The average time taken for removal of foreign bodies in the upper, middle, and lower esophagus was 7.0 ± 5.3, 8.3 ± 6.3, and 3.3 ± 1.2, respectively. Anastomosis foreign bodies were often removed using a trap, and the average time taken was 6.2 ± 4.1 min. When removing the foreign body in the stomach, appropriate instrument should be selected according to the shape of the foreign body. In order to avoid scratching the mucosa by the tip of the foreign body, a transparent cap or a self-made protective device can be used. The average time used was 8.4 ± 1.7 min. Duodenal foreign body was usually dragged into the stomach tbefore removal, and the average time taken was 9.2 ± 3.1 min. Colonic foreign bodies mainly occurred in the sigmoid colon and were very difficult to remove. A clamp was usually used to clamp one end of the foreign body, exert to the opposite side, cause it to be parallel to the intestinal lumen, and then remove. The longest time was taken for colonic foreign bodies, with an average time of 15.6 ± 8.0 min. The success rate of endoscopic removal of foreign bodies in the digestive tract was 97.2% (106/109).
CONCLUSION Individualized endoscopic removal of gastrointestinal foreign bodies is a safe and effective method.
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Affiliation(s)
- Huan Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Dong-Lei Lin
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Xiao-Feng Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Ya-Wei Qu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Li-Sha Wu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Peng Yu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei-An Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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Masarapu V, Xia E, Son H. Esophageal emergencies: another important cause of acute chest pain. Insights Imaging 2020; 11:109. [PMID: 33034721 PMCID: PMC7547061 DOI: 10.1186/s13244-020-00915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
A variety of esophageal pathologies can present emergently with a chief complaint of acute chest pain. Computed tomography (CT) is often the first line of imaging in esophageal emergencies and provides useful information-even without an initial suspicion-when used in conjunction with other imaging modalities such as esophagography and direct visualization. We review various urgent and emergent esophageal disease entities which may manifest as acute chest pain, with an emphasis on CT and ancillary imaging appearances, while discussing management according to their emergency. Radiologists should be familiar with the imaging findings of these esophageal emergencies in order to provide an accurate diagnosis and recommend timely and appropriate management.
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Affiliation(s)
- Venkat Masarapu
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Eva Xia
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Hongju Son
- Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA, 19141, USA
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De Luca L, Maltoni S. Is naso-pharyngeal swab always safe for SARS-CoV-2 testing? An unusual, accidental foreign body swallowing. Clin J Gastroenterol 2020; 14:44-47. [PMID: 32951147 PMCID: PMC7502028 DOI: 10.1007/s12328-020-01236-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
Abstract
Long and sharp objects can be foreign body intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, localization in gastrointestinal tract, patient’s clinical conditions, occurrence of symptoms, or onset of complications. We present a case of a 47-year-old male with no known comorbidity, who accidentally swallowed a portion of a naso-pharyngeal swab half-broken during the second diagnostic test for SARS-CoV-2. The intact swab had a total length of 15 cm and was made of wood. The patient was asymptomatic, laboratory tests were normal, and neck-chest-abdominal X-ray and CT scan were negative for major complications. Upper gastrointestinal endoscopy was promptly performed to prevent the long sharp swab from crossing the pylorus leading to serious complications and, therefore, risk surgical intervention. The patient was intubated and the procedure was carried out under general anesthesia. In the gastric body, broken naso-pharyngeal swab was detected among the food debris, and using a latex rubber hood, the 7.5 cm foreign body was removed with a retrieval alligator-tooth forceps. Our hospital is located in a high-risk area of COVID-19 outbreak where many naso-pharyngeal swabs are performed, and to our knowledge, this is the first report of swab ingestion during SARS-CoV-2 test.
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Affiliation(s)
- Luca De Luca
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Piazzale Cinelli, 1, 61121, Pesaro, PU, Italy.
| | - Stefania Maltoni
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Piazzale Cinelli, 1, 61121, Pesaro, PU, Italy
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Ibrahim Y, Browning S. The pressure effects of different commercially available beverages on food boluses in vitro. Eur Arch Otorhinolaryngol 2020; 278:437-443. [PMID: 32930842 DOI: 10.1007/s00405-020-06347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Acute oesophageal food impaction is a common and potentially life-threatening condition. Effervescent agents have been used to manage these patients. To date, there have not been any studies comparing the differences in commercially available beverages in relieving food bolus impaction. The aim of this study was to design an in vitro system where the pressure changes generated by different commercially available beverages could be compared in the presence of different food items. METHODS A closed in vitro system was designed using a flask and manometer. Different food items [potato, beef, chicken, and no food item (control)] and different beverages (Coca-Cola®, lemonade, 7 Up Free, Prosecco and water) were inserted into this system in turn. For each food item and beverage, pressure changes (cmH2O) were recorded over a 3-min period. RESULTS Comparing the different food items, the potato appeared to cause the greatest increases in pressure over most time points with all beverages except Coca-Cola® and water. Between the beverages, the lemonade and Prosecco seemed to generate the greatest pressure changes; lemonade generating higher (but non-significant) pressures than the Prosecco with the potato and control. CONCLUSION Our study demonstrates that, in vitro, amongst the beverages, lemonade and Prosecco generated the greatest increases in pressure, whilst potatoes generated a greater reaction than the other food items. These findings need to be studied in further detail and, if deemed clinically relevant, may prompt further investigation for their use in the clinical setting.
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Affiliation(s)
- Yousef Ibrahim
- Department of Otolaryngology, Morriston Hospital, Swansea, SA6 6NL, UK.
| | - Simon Browning
- Department of Otolaryngology, Morriston Hospital, Swansea, SA6 6NL, UK
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Marquardt P, Derousseau T, Patel N. Foreign Body Ingestion: A Curious Case of the Missing Denture. Geriatrics (Basel) 2020; 5:geriatrics5030049. [PMID: 32933211 PMCID: PMC7555874 DOI: 10.3390/geriatrics5030049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
Foreign body ingestion is an under-recognized hazard in adults, especially in the elderly where it may lead to significant morbidity and even mortality. We present the case of an elderly patient who ingested her denture without any reported symptoms. After early recognition, endoscopic retrieval of the item was performed. We provide support for endoscopy as a safe and effective intervention for removing ingested foreign bodies in the geriatric population.
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40
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Arman S, Vijendren A, Lyons M. Outcome and follow-up of patients requiring emergency oesophagoscopy for food bolus obstruction over a 5-year period. Otolaryngol Pol 2020; 74:29-32. [PMID: 32398386 DOI: 10.5604/01.3001.0013.5261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION OFBO is a common occurrence in the emergency setting. Endoscopic removal via rigid or flexible oesophagoscopy is only performed following failure to pass the obstruction after a period of observation and medical management. Despite recommendations from the ESGE, there is currently a lack of high-quality evidence to support the diagnostic work-up of these patients. PURPOSE The purpose of this single centre study was to assess the outcome and follow-up of this population over a 5-year period. We retrospectively collected data regarding all patients undergoing emergency oesophagoscopy between 2012-2017 and recorded their outcomes and subsequent follow-up. R esults: We found that only 33% of patients had diagnostic investigations performed post-operatively and oesophageal pathology was detected in 44% of those investigated. Eosinophilic oesophagitis was the most common diagnosis and OGD was more likely to detect pathology compared to other modalities. C onclusion: Our study suggests that our findings could have been higher had all our patients underwent further investigation. Therefore, we would recommend a diagnostic work-up in all patients following a discussion of the risks associated with an endoscopic examination. We thoroughly support further large-scale collaborative research which can shed better light of evidence on the topic.
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Affiliation(s)
- Sam Arman
- Lister Hospital, Stevenage, United Kingdom
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Esophageal foreign bodies: observational cohort study and factors associated with recurrent impaction. Eur J Gastroenterol Hepatol 2020; 32:827-831. [PMID: 32243348 DOI: 10.1097/meg.0000000000001717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Esophageal foreign bodies, including food bolus impaction, represent a common clinical problem. The prevalence of underlying esophageal disease depends on study design and degree of suspicion of a structural or functional esophageal abnormality. Aim of this study was to analyze factors associated with recurrent impaction. METHODS The prospectively collected database at a University Hospital and Swallowing Center was reviewed from January 2012 to June 2019 to identify all patients admitted for esophageal foreign bodies. Patients who underwent an emergency endoscopic procedure represented the final study sample. Patient characteristics, including history of previous esophageal foreign bodies, and type of endoscopic procedure were collected. RESULTS Sixty-five patients, 41 males and 24 females with a median age of 59 years, underwent emergency endoscopy for esophageal foreign bodies during the study period. Food bolus was the most common foreign body (n = 43, 66%). Flexible endoscopy was successful in retrieving or pushing the foreign bodies in the stomach in 91% of patients. In 54% of patients, impaction was secondary to an underlying esophageal disorder, which was previously unrecognized in half of them. Recurrent impaction was more common in patients with esophageal disease (P < 0.011). Surgical therapy was required in 4 patients (6.1%). CONCLUSIONS Food bolus impaction is a common sentinel event in patients with underlying esophageal disease and is associated with recurrent impaction. Diagnostic endoscopy with biopsies should possibly be performed at the first episode of impaction. Patients with negative biopsies should undergo barium swallow study and high-resolution esophageal manometry.
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Parikh MP, Garg R, Gupta N, Sarvepalli S, Singhal A, Lopez R, Thota PN, Sanaka MR. National trends in healthcare outcomes and utilization of endoscopic and surgical interventions in patients hospitalized with esophageal foreign body and food impaction. Dis Esophagus 2020; 33:doaa018. [PMID: 32440674 DOI: 10.1093/dote/doaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/22/2020] [Indexed: 12/11/2022]
Abstract
The incidence and number of emergency room visits for esophageal foreign body and food impaction (EFB) are on the rise. However, its impact on the rate of inpatient admissions, utilization of endoscopic and surgical interventions, and healthcare outcomes is poorly understood. We conducted a study to analyze these outcomes using the national inpatient sample (NIS) database. Data on all adult patients (≥18 years) admitted with EFB was extracted from the NIS database from 1998 to 2013. The temporal trends in discharge rates as well as in length of stay (LOS), hospital charges, and in-hospital mortality rates were assessed by linear and polynomial regression. Average age, gender, and race of inpatients with EFB were not significantly different between 1998 and 2013. The rate of EFB admissions increased significantly from 1998 to 2005 followed by a decline thereafter (p = 0.01). LOS and hospital charges significantly increased by 0.02 days/year (p = 0.015) and $1,547/year (p < 0.001), respectively. There was a trend towards less utilization of overall esophagogastroduodenoscopy (EGD) over the last decade with significant lower use of EGD within 24 hours in 2013 as compared to 1998 (p = 0.026). The rates of surgical intervention and inpatient mortality did not change significantly over the study period. The rate of inpatient admissions for EFB is on the decline in recent years, suggesting the modern-day practice of cost-effective medicine. Hospitalization costs for EFB have increased, whereas rates of surgical intervention and inpatient mortality have not changed significantly over the study period.
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Affiliation(s)
- Malav P Parikh
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Rajat Garg
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Niyati Gupta
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Shashank Sarvepalli
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Akhil Singhal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Rocio Lopez
- Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, USA
| | - Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
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Marashi Nia SF, Aghaie Meybodi M, Sutton R, Bansal A, Olyaee M, Hejazi R. Outcome, complication and follow-up of patients with esophageal foreign body impaction: an academic institute's 15 years of experience. Dis Esophagus 2020; 33:5734961. [PMID: 32052054 DOI: 10.1093/dote/doz103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients' admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki's ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P < 0.001). EFBI-related esophageal adverse events (AEs) occurred in 4.9% of cases. Cardiovascular and pulmonary AEs occurred in 1.5 and 2.9%, respectively. Logistic regression did not find any predictor for AEs occurrence. EFBI managed very well with endoscopic treatments. Despite the emerging data about the safety of the push technique, there are still concerns regarding its adverse events especially the risk of perforations. Our study shows no significant difference in adverse events between different types of techniques.
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Affiliation(s)
| | - Mohamad Aghaie Meybodi
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Richard Sutton
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ajay Bansal
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mojtaba Olyaee
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Reza Hejazi
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
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Willenbring BA, Schnitker CK, Stellpflug SJ. Oral nitroglycerin solution for oesophageal food impaction: a prospective single-arm pilot study. Emerg Med J 2020; 37:434-436. [PMID: 32366615 DOI: 10.1136/emermed-2019-209320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thirteen episodes of oesophageal food impaction (EFI) per 100 000 people present to a medical setting each year. Several pharmacological interventions meant to relieve such impactions have been explored; none have proven superior. OBJECTIVES Perform a single-arm feasibility study of oral nitroglycerin solution for EFI. METHODS Twenty adult patients presenting to a single urban tertiary medical centre thought to have EFI were given up to three doses of 0.4 mg nitroglycerin solution orally and evaluated for resolution of symptoms, new symptoms and vital signs. Patients with intractable vomiting, haemodynamic instability, airway compromise, oesophageal perforation, coronary ischaemia or presentation delayed greater than 12 hours were excluded. RESULTS 17 of 20 enrolled subjects received the intervention. The average duration of symptoms prior to intervention was 285 min (SD=187). Four subjects did not tolerate the intervention (inability to swallow or headache). Two of 17 (11.8%) subjects obtained temporally proximal symptom resolution: 11 min after the second dose, and 7 min after the third dose. Seven also received glucagon during their visit, with 0% temporally proximal symptom resolution. Fifteen underwent endoscopy, with food bolus identified in 12. One subject had brief and mild hypotension with spontaneous resolution. Two subjects developed a headache after nitroglycerin administration. The median length of stay for those who found relief without endoscopy was 195 min (range 129-261) vs 374 min (range 122-525) among those with endoscopy. CONCLUSION The observed rate of relief after oral nitroglycerin solution for EFI is disappointing but comparable to previous glucagon, benzodiazepines and effervescent beverage studies, and that of placebo. Oral nitroglycerin solution appears to be well tolerated among those able to swallow, although in our sample several subjects were unable to tolerate swallowing entirely.
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Affiliation(s)
| | | | - Samuel J Stellpflug
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota, USA
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Krill T, Samuel R, Vela A, Marcondes F, Zaibaq J, Guturu P, Parupudi S. Outcomes of delayed endoscopic management for esophageal soft food impactions. Gastrointest Endosc 2020; 91:806-812. [PMID: 31874159 DOI: 10.1016/j.gie.2019.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Food impactions are a common reason for emergent upper endoscopy. Current guidelines call for urgent upper endoscopy (within 24 hours) for food impactions without complete esophageal obstruction and emergent endoscopy (within 6 hours) for those with complete esophageal obstruction. Multiple adverse events can arise from esophageal foreign bodies. Cases with longer delays from symptom onset to presentation have been associated with higher rates of surgical intervention. However, data on esophageal soft food impactions are scant. We set out to determine differences in outcomes for food impactions undergoing intervention within 12 hours versus over 12 hours of symptom onset. METHODS A retrospective review of medical records was conducted to identify patients who presented to our hospital with an esophageal soft food impaction and underwent an EGD between January 2010 and January 2018. Patients were divided into 2 groups based on the timing from symptom onset to EGD. An EGD within 12 hours was considered an early intervention and over 12 hours was considered a delayed intervention. Patients who had ingested bones or hard objects were not included. Primary outcomes studied were rates of aspiration, admission, local esophageal adverse events, and 30-day all-cause mortality. RESULTS We identified 110 patients with a soft food impaction who underwent an EGD. Forty- two patients had an early intervention and 68 a delayed intervention. There were no differences in basic demographics and comorbidities. Additionally, there were no differences in rates of local esophageal adverse events, aspiration, admission, or 30-day mortality. Multivariate analysis revealed endoscopic accessory use was associated with increased odds of local esophageal adverse events (odds ratio, 6.37; P = .01). CONCLUSIONS The overall rates of serious adverse events in esophageal soft food impactions are low. Delayed intervention is not associated with increased adverse events or 30-day mortality compared with early intervention. However, accessory use is associated with higher adverse event rates.
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Affiliation(s)
- Timothy Krill
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ronald Samuel
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Andrew Vela
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Felippe Marcondes
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jenine Zaibaq
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Praveen Guturu
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sreeram Parupudi
- Department of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
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Guo C, Wu J, He H, Liu H, Wang Y, Wei N, Wang C, Lin W, Su H. Evaluation of the medical economics and safety: two methods for the endoscopic removal of jujube pits. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:209-213. [PMID: 30449119 DOI: 10.17235/reed.2018.5794/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to evaluate the medical economics and safety of two methods for the endoscopic removal of jujube pits, one with a transparent cap combined with a stone basket and the other with a transparent cap combined with foreign body forceps. METHODS consecutive patients with a suspected jujube pit ingestion in the esophagus between January 2008 and December 2017 were enrolled into the study. Fifty-three patients who met the criteria were divided into two groups. Group A patients were treated by a transparent cap combined with a stone basket and group B patients were treated by a transparent cap combined with foreign body forceps. The following clinical data were collected: age, sex, location of jujube pits, complications, operation time, extraction success and average hospital costs. RESULTS a total of 53 patients who met the criteria were enrolled into the study; 29 cases in group A and 24 cases in group B. Endoscopic removal was successful in 98.1% (52/53) of the patients and the remaining 1.9% (1/53) required surgery. Severe complications were less frequent in group A than in group B (p = 0.017). Surgery time was not significantly different between the two groups (p = 0.647). The extraction success in group A was higher than in group B (p = 0.001). The medical costs including the total cost, inspection, treatment, radiation and drug cost were not significantly different between the two groups (p > 0.05 in all cases). CONCLUSION endoscopic baskets are suitable for cases of jujube pit ingestion and have a higher extraction success and a lower proportion of severe complications. Surgery time was not significantly extended and the medical costs did not increase.
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Affiliation(s)
- Chunmei Guo
- Gastroenterology, Beijing Shijitan Hospital, China
| | - Jing Wu
- Beijing Shijitan Hospital,Capital Medical University
| | - Haiyan He
- Beijing Institute of Space Mechanics and Electricity
| | - Hong Liu
- Beijing Shijitan Hospital, Capital Medical University
| | - Yadan Wang
- Beijing Shijitan Hospital, Capital Medical University
| | - Nan Wei
- Beijing Shijitan Hospital, Capital Medical University
| | - Canghai Wang
- Beijing Shijitan Hospital, Capital Medical University
| | - Wu Lin
- Beijing Shijitan Hospital, Capital Medical University
| | - Hui Su
- Beijing Shijitan Hospital, Capital Medical University
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Arias-González L, Rey-Iborra E, Ruiz-Ponce M, Laserna-Mendieta EJ, Arias Á, Lucendo AJ. Esophageal perforation in eosinophilic esophagitis: A systematic review on clinical presentation, management and outcomes. Dig Liver Dis 2020; 52:245-252. [PMID: 31836305 DOI: 10.1016/j.dld.2019.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
There is evidence of an increased fragility in the inflamed esophagus of patients with eosinophilic esophagitis (EoE). We performed a systematic review on presentation, management and outcomes of and surgical interventions for esophageal perforation in these patients, by searching in the MEDLINE, Embase and Scopus databases. Of the 599 references identified, 41 full-papers and 9 abstract met the inclusion criteria. Overall, 76 esophageal perforation episodes in 70 individual patients aged between 9 and 65 years were reported. 51 patients had not been diagnosed with EoE at the time of perforation; 14 patients had an untreated disease and the remaining were non responsive to therapy. Acute or progressive pain after long-lasting dysphagia and food impaction was the most common symptom leading to diagnosis in 42 patients who presented with Boerhaave syndrome. Pushing impacted food into the stomach led to perforation in 5 cases. Eight episodes appeared after dilation. CT scans demonstrated perforation in 82.4% of patients. Conservative management (including esophageal stenting) was used in 67.1% patients. The 25 remaining patients underwent surgery. Recovery was uneventful in the vast majority of patients. No death was reported. Active inflammation due to undiagnosed or untreated EoE was present in most cases of esophageal perforation. Conservative treatment of perforation should always be considered in EoE.
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Affiliation(s)
- Laura Arias-González
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Esther Rey-Iborra
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Miriam Ruiz-Ponce
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Emilio J Laserna-Mendieta
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Ángel Arias
- Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Research Unit, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain.
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Long B, Gottlieb M. Is Glucagon Effective for Relieving Acute Esophageal Foreign Bodies and Food Impactions? Ann Emerg Med 2020; 75:299-301. [DOI: 10.1016/j.annemergmed.2019.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 10/26/2022]
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Tsuruya K, Chino O, Tanaka Y, Shimma Y, Tsuda S, Kikuchi M, Shiozawa H, Aoki J, Nakamura T, Hanashi T, Suzuki T, Matsushima M. Successful combination of endoscopic and laparoscopic removal of multiple ingested needles: A case report. Medicine (Baltimore) 2020; 99:e19343. [PMID: 32080155 PMCID: PMC7034740 DOI: 10.1097/md.0000000000019343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established. PATIENT CONCERNS A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before. DIAGNOSIS Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon. INTERVENTIONS A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later. OUTCOMES The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications. LESSONS Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.
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Affiliation(s)
- Kota Tsuruya
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Osamu Chino
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Yoichi Tanaka
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Yoshimasa Shimma
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Shingo Tsuda
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Masahiro Kikuchi
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hirokazu Shiozawa
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
| | - Jun Aoki
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
| | - Tomoki Nakamura
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Tomoko Hanashi
- Department of Surgery, Digestive and Liver Disease Center, Tokai University Tokyo Hospital
| | - Takayoshi Suzuki
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
| | - Masashi Matsushima
- Department of Internal Medicine, Digestive and Liver Disease Center, Tokai University Tokyo Hospital, Tokyo
- Department of Internal Medicine (Gastroenterology), Tokai University School of Medicine, Isehara
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Feng S, Peng H, Xie H, Bai Y, Yin J. Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients. EAR, NOSE & THROAT JOURNAL 2020; 99:251-258. [PMID: 31996037 DOI: 10.1177/0145561319901033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data. METHODS All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed. RESULTS A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor. CONCLUSIONS Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.
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Affiliation(s)
- Shui Feng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Peng
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Xie
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yunbo Bai
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jinshu Yin
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing, China
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