Early Upper Endoscopy for Admission of Foreign Body in Esophagus Significantly Decreases Complications and Mortality: Presidential Poster

Abstract

Introduction: Current ASGE guidelines recommend emergent removal of esophageal food bolus impactions and foreign bodies though this is two star (low quality evidence) guideline and further research has been recommended in this area. We aim to study the differences in outcomes based on early versus late esophagogastroduodenoscopy (EGD) among patients presenting with a foreign body in esophagus using a large national inpatient sample database. Methods: The National Inpatient Sample (NIS) databases (2002-2011) is the largest all payer inpatient care database, containing around 5 to 8 million hospitalizations from approximately 1000 hospitals in the USA. The patients presented with foreign body in esophagus and EGDs were identified using the ICD-9 codes. Early EGD was defined as being performed on the day of admission. Various outcomes such as inpatient mortality, acute respiratory failure (ARF)/aspiration pneumonia (AP), iatrogenic pneumothorax, endotracheal intubation, length of stay (LOS), and total hospitalization cost were evaluated. Multivariate logistic regression analysis adjusted for age, sex, race, complications and Elixhauser comorbidities was used to identify independent predictors of inpatient mortality. Results: Our study included 21,475 hospitalizations related to a foreign body in esophagus. The mean age of the study population was 51.2 years with 71.8% white and 54.9% male. Overall 55.8% of hospitalizations had an early EGD. There was a significantly lower rate of ARF and AP requiring endotracheal intubation >96 hours among hospitalizations with early EGD (ARF/AP: 9.2% vs 12.6%, p < .001; intubation: 0.7% vs 1.3%, p < .001). Hospitalizations with early EGD had a significantly lower rate of inpatient mortality. (0.6% vs 1.9%, p < .001). Multivariate logistic model identified age, delay in EGD, requiring endotracheal intubation, ARF/AP and having multiple comorbid conditions as independent risk factors associated with inpatient mortality (Table 1). Overall hospitalization mean LOS and financial charges were significantly lower among hospitalizations with early EGD. (LOS: 2.0 vs 4.2 days, p < .001; financial cost: $16,634 vs $24,390, p < .001).Table 1: Independent risk factors associated with inpatient mortality among hospitalizations with foreign body in esophagusConclusion: Our study showed significantly reduced finalcial burden, and lower rates of complications and inpatient mortality related to foreign body in esophagus among individuals who undergo early EGD. Our study adds high quality evidence to current ASGE guideline by utilizing a large nationally representative hospitalization sample.