Food and Foreign Body Impaction In Upper GI Tract

Abstract

Background: Ingestion of foreign bodies and food impaction are the most common cause of esophageal obstruction, which is considered as acute emergency, this obstruction can be caused by soft, blunt, and sharp objects. Endoscopy is considered as the main therapeutic procedure, surgical intervention is rarely needed. Methods: a retrospective study of all patients' records with acute esophageal obstruction or presence of radio-opaque foreign body in esophagus or stomach. Urgent EGD used to be done in outpatient clinic, or elective, if the patient has the foreign body days in the stomach. XQ10, XV10, and Q20 Olympus gastroscopes were used, retrieval was carried out by snare or tetrapode grasper, over tube was used once indicated. Conscious sedation, by using titrated doses of Medazolam, or GA if sedation was not enough. Patients were classified according to esophageal pathology, and type of obstructing object. Results: All records of 77patients from 1992-Nov 2003 presented with either esophageal obstruction, or a radio-opaque shadow were reviewed, mean age 28.2 years ( 1-80 years), total events 81, M:F 38:39, total number of EGD in that period 4522. Cause of obstruction, and management were as follows:- (Insert table) * Soft, ** Blunt, **Sharp Four patients with gastric bezoars 3 were removed, and one trichobezoar was fragmented and pushed completely on 3rd sessions. Three pins, in 3 patients were embedded in full stomach and could not be seen, passed with stool. The blade was removed by snare with over tube protection. And in 3 patients negative EGD. Conclusion: foreign bodies and impacted food can be successfully managed by gastroscopy in most cases, (93%). Failure is due to embedded bones in upper esophagus, and surgery is the treatment. Either extracting or pushing techniques are effective. Coins and coins like impaction occurred in normal esophagus, mainly in children, while soft bolus impaction occurred in an abnormally narrowed esophagus.