Endoscopy for repeatedly ingested sharp foreign bodies in patients with borderline personality disorder

Abstract

The general guidelines on the management of ingested foreign bodies (FBs) do not address specific aspects raised by psychiatric patients, particularly in patients with borderline personality disorders (BPD) who repeatedly ingest FBs. The aim of this survey was to collect data on experience and opinions on the management of FBs in psychiatric patients with BPD and to review the relevant literature. A survey focusing on the indication and the timing of endoscopy for sharp FB removal in patients with BPD was e-mailed to 215 gastroenterologists, psychiatrists, and surgeons in Switzerland, Germany and Austria, discussing this clinical problem using a specific case vignette. Responses were received from 63 of 215 (29%) contacted physicians. Two-thirds of the respondents knew patients with BPD who had swallowed FBs repeatedly; 86% recommended removing sharp FBs endoscopically even in the case of repeated FB ingestion and 14% of respondents argued against emergent endoscopic FB removal in the case of repeated ingestions. Different specialities expressed partially divergent opinions regarding the management of these patients. Repeated FB ingestions can be a problem in patients with BPD. Although published data show that the perforation risk of unremoved FBs is low, most clinicians support repeated endoscopies also in the case of repeated FB ingestions. Nevertheless, in selected cases, repeated endoscopies need to be discussed and an interdisciplinary consensus and/or the involvement of an ethical committee is advised.