A152 FOREIGN BODY INGESTIONS AT A TERTIARY CARE CENTRE - A QUALITY ASSURANCE STUDY

Abstract

Abstract Background Foreign body ingestion and esophageal food bolus impaction are common emergencies encountered by gastroenterologists. If not treated in a timely fashion these can result in significant morbidity, or even mortality. The mainstay of diagnosis and therapy is endoscopy. Guidelines regarding timing of endoscopy have been published by both the American and European Societies of Gastrointestinal Endoscopy, and both suggest emergent endoscopy, meaning within 2 to 6 hours, for complete esophageal obstructions. There is relatively sparse data regarding the endoscopic techniques used in real world practice. Aims This is a quality assurance study looking at the endoscopic practices at an adult tertiary care hospital in Halifax, Nova Scotia with respect to foreign body and food impaction management. Methods The hospital records of all patients presenting with ingested foreign bodies or esophageal food bolus impactions between May 2018 and July 2019 were included. Patients were identified by searching the call-back forms used by our department which documents all on-call endoscopy cases. This was then cross-referenced by endoscopy nursing charting which documents every endoscopy performed. Information such as demographics, obstruction type, endoscopic method of removal, complications, time between consultation and endoscopy, underlying pathology, and others were analyzed. Results 70 cases were identified. Average patient age was 51.3 years old (range 16–96). 18 (25.7%) were female and 52 (74.3%) were male. 64 cases (91.4%) were esophageal food impactions and 6 (8.57%) were foreign body ingestions. Of the food impactions, 39 cases (60.9%) were cleared by the push/slide-by technique only and 10 (16.7%) were relieved using instruments such as snares, forceps, or nets. 15 (23.4%) passed spontaneously prior to scope, of which 7 received glucagon. An overtube was used in 1 case (0.16%). Complications occurred in 5 (7.8%) cases and included 3 mucosal tears, 2 of which required therapeutic interventions, and 2 episodes of oxygen desaturation in which the procedure was aborted. Complete obstructions occurred in 42 (65.6%) cases with average time of consultation to endoscopy of 2.4 hours. However, 3 (7.1%) cases exceeded 6 hours. The most common pathology was eosinophilic esophagitis with 20 cases (31.3%). Ingested foreign bodies included 2 long objects, 3 sharp objects, and a cylindrical battery, and all but one were in the stomach. 5 (83.3%) cases used an overtube. No complications occurred. Conclusions At our institution 67/70 (95.7%) cases were performed within the timelines recommended by society guidelines. No complications occurred in the cases not performed within those time limits. An overtube was used in only one case in which a food bolus was retrieved out of the esophagus. Overall this study suggests that our centre is meeting recommended targets, however there is room for improvement. Funding Agencies None