Abstract
BackgroundTimely intervention is essential for the successful removal of ingested foreign bodies. Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. However, because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes.MethodologyWe reviewed charts of patients who underwent EGD for foreign body removal at an academic quaternary center between January 01, 2012, and December 31, 2020. We defined successful EGD as retrieval of the foreign body at the first attempt and not requiring subsequent endoscopy or surgical intervention. We performed descriptive and inferential statistical analyses and conducted classification and regression trees to compare endoscopy procedure length (EPL) and hospital length of stay (HLOS) between different locations.ResultsWe analyzed 77 patients, of whom 13 (17%) underwent endoscopy in the ICU, 46 (60%) in the OR, and 18 (23%) in the ED. Endoscopic removal failed in four (5%) patients. Endoscopy length was significantly shorter in the OR (67 (48-122) minutes) versus the ICU (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009). Time to procedure was similar if the procedure was performed in the ED (278 minutes), the ICU (331 minutes), or the OR (378 minutes). The median (interquartile range) of HLOS for the OR group (0.87 (0.54-2.03) days) was significantly shorter than the ICU group (2.26 (1.47-6.91) days, P = 0.007).ConclusionsWhile performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter EPL and HLOS, no location was inferior for overall outcomes. Further prospective and randomized studies are needed to confirm our findings.
Highlights
Patients who accidentally ingest foreign bodies typically present to an emergency department (ED) for care
Endoscopy length was significantly shorter in the operating room (OR) (67 (48-122) minutes) versus the intensive care unit (ICU) (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009)
While performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter endoscopy procedure length (EPL) and hospital length of stay (HLOS), no location was inferior for overall outcomes
Summary
Failure in the timely removal of sharp foreign body ingestion or food impaction can result in serious complications, such as esophageal perforation, obstruction, bacteremia, aortoesophageal fistula, and tracheoesophageal fistula formation [5,6,7,8,9]. When timely endoscopy in the endoscopy suite is not feasible, these procedures are commonly performed in secondary locations, such as the intensive care unit (ICU), the ED, and the operating room (OR). Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. Because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes
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