Efficacy of Endoscopic Interventions for Esophageal Foreign Body Removal at Tertiary Care Center

Abstract

Introduction: Foreign body (FB) ingestion is a common indication for endoscopic intervention. While a majority of accidentally ingested foreign bodies pass spontaneously, endoscopy is required in up to 76% patients in with intentional ingestions. Need for surgical intervention in difficult cases is quoted to be as high as 16%. The primary aims of this study are to analyze the techniques and efficacy of endoscopic intervention in esophageal FB removal at a tertiary care center. Methods: All patients above 18 years of age admitted with a diagnosis of esophageal FB between 1/1/2010 to 12/31/2013 were included in study. Using electronic health records data on patient demographics, co-morbidities, type and location of FB, use of glucagon, endoscopic procedure details and need for surgical intervention were collected. Statistical analysis was performed using unpaired t test, fisher's exact test and chi-square test. Results: A total of 125 patients were enrolled. Average age for our patient population was 42.08 years. 72% were males, 38% patients were active smokers and 29% patients consumed alcohol. Lower 1/3 of esophagus was most common site of impaction (37% cases). Glucagon was tried in 49 (39%) patients with food impaction and relieved symptoms in 15 patients (30% success rate) averting need of urgent endoscopy. In remaining 110 patients, 72 (65%) patients had food impaction, 24(22%) patients had blunt FB and 14 (13%) had sharp FB impaction. FB was successfully removed in 89 patients (81%) via endoscopy. Success rate were found to differ based on type of FB (significantly higher for food bolus (94%, OR-12, P - 0.001) as compared to blunt (67%) or sharp objects (43%). Endoscopic removal was more successful for impacted FB in lower 1/3 of esophagus, (OR-11 P - 0.008) and if the underlying etiology was schatzki ring or stricture (OR - 6.23, P < 0.05) as compared to normal appearing esophagus. Most commonly used instruments for FB removal included snare, rothnet and rat tooth/ alligator forceps. Rigid upper endoscopy was required in 5 cases and only 4 patients underwent surgical exploration to remove FB after attempt at endoscopic retrieval was unsuccessful. Conclusion: Flexible upper endoscopy is an effective modality esophageal FBs removal. Glucagon injection should be offered first line to all patients with food impaction on a regular basis (unless contraindicated) as a safe option and can obviate the need for unnecessary emergent EGD.