Foreign Body Impaction: A Decade Review

Abstract

Introduction: Foreign body impaction in the digestive tract represents the second most common gastrointestinal emergency, with endoscopic removal as the treatment of choice. The aim of our study was to define the demographics and outcomes of patients who were treated for foreign body impaction in two urban academic hospitals. Methods: Endoscopic procedures from two urban academic hospitals over 10 years were assessed for inclusion using retrospective data review. Cases with procedure indication of a foreign body in the esophagus or stomach and endoscopy confirming either “food” or “foreign body” were included. All data were de-identified and aggregated prior to analysis. Comparison with restaurant density obtained from the Department of Health was made to assess for potential risk factors. Results: A total of 283 patients were included (Table 1). Most patients were male (70.3%), with a mean age of 49.9 years. These cases represented 0.7% of all endoscopies over the study period. Most procedures were done in the emergency department (ED) (57%), under conscious sedation with midazolam and fentanyl (81%), with sedation given by the gastroenterologist (80%). The most common foreign body was food matter (88%) and the most common impaction site was the distal third of the esophagus (38%). Other impacted items included batteries, caps, coins, dentures, pens, toothpicks, and utensils. An etiology for obstruction, such as findings consistent with eosinophilic esophagitis, a hiatus hernia or an esophageal ring/stricture was found in less than half of the cases. Three procedures (1%) had complications. Most of cases (70%) presented in the hospital setting with zip-code of highest restaurant density (representing 14% of all restaurants in the region), despite this hospital having 25% less ED visits overall. The remaining 30% of cases presented at the hospital near only 2% of restaurants in the region. Conclusion: At two urban academic hospitals, endoscopic removal of foreign body in the digestive tract most frequently was performed in the ED under gastroenterologist-guided moderate sedation. The most likely impaction site was the distal third of the esophagus and many cases lacked an absolute etiology. Our findings clearly suggest an increased occurrence of esophageal foreign body impaction in areas with higher density of commercial food service. This study underscores the importance of access to appropriate endoscopic equipment in the ED and during times when endoscopy suite is closed.486_A Figure 1. Demographics and Outcomes in Foreign Body Impaction486_B Figure 2. Endoscopic Findings of Food Bolus Impaction in Esophagus