Foreign Body Removal in Childhood – International Study about Preference, Performance and Complications

Abstract

Background: There is an increasing number of publications reporting on flexible bronchoscopy as primary method for foreign body removal in children rather than rigid bronchoscopy recommended by the leading scientific societies. To obtain objective data on this disagreement, we analysed the current situation and practice, defined complications and collected data on the availability and success rate of both techniques. Methods: A methodological and case-related anonymous questionnaire was sent to different paediatric units. The questions concerned following points of interest: Which technique (rigid and/or flexible) was used for foreign body removal (preference vs. performance) and which complications occurred. Results: In total 145 physicians from 43 countries agreed to contribute cases to the study. During ten months a total of 446 foreign body removals were reported. Both flexible and rigid techniques were preferred in the vast majority of the centres. In total 278 cases were performed with rigid bronchoscopes, 168 cases with flexible instruments. Predetermined standardized complications were mild, moderate and severe depending on time of interruption of the procedure. Overall, severe complications occurred in 1% of all rigid procedures and in 0.8% of the flexible ones. Most complications occurred in cases with difficult course already before the intervention. Conclusion: Despite current recommendations and published standards, the flexible technique for removal of foreign bodies in childhood is performed in many centres with acceptable success rate and complications comparable to the rigid bronchoscopy.