Practice Patterns of Gastroenterologists and Surgeons in the Management of Esophageal Foreign Body Impaction

Abstract

Introduction: Esophageal foreign body impaction (EFBI) is a relatively common gastrointestinal emergency usually requiring an urgent endoscopic procedure to relieve the impaction. Esophagogastroduodenoscopy (EGD) is an efficient and relatively safe procedure for the management of EFBI, provided it is performed by competent providers to a high quality standard. Performance of EGDs in the US is shared by multiple specialties, including gastroenterologists, surgeons, and some primary care physicians. Multiple factors are known to influence the quality and safety of an upper endoscopy, but data regarding the influence of the specialty of the endoscopist on the outcome of EFBI treatment is lacking. The aim of this study is to determine whether there are differences in EFBI management between surgeons and gastroenterologists.Table: Table. Comparison Between Gastroenterologists and Surgeons in EFBI ManagementTable: Table. Techniques Used by Gastroenterologists and Surgeons for EFBI RemovalMethods: This study is a retrospective chart review of all patients who presented with EFBI at a single institution between 10/1/2013 and 9/30/2015. Charts of patients older than 18 years, with ICD-9 diagnosis code 935.1, “Foreign body of the esophagus,” were reviewed. Pertinent data were extracted, including age, gender, time to procedure, endoscopist specialty, technique used, complications, and counseling. Bivariate analyses were performed. Means were compared with t test and proportions with the ÷ 2 test. Results: Among 93 upper endoscopies for removal of EFBI reviewed, 68 were performed by gastroenterologists. There was no significant difference between the groups in the metrics of time to procedure, frequency of treatment of underlying strictures, complication rate, or success rate. Surgeons performed push endoscopy at a significantly higher rate (p=0.009). In addition, documentation of follow-up instructions were significantly higher among patients treated by gastroenterologists (p=0.009). Conclusion: This study shows a high success rate for removal of EFBI, regardless of the endoscopist specialty. Surgeons were more likely to perform push endoscopy without an increase in complication rate. Documentation regarding the addition of new medications and outpatient follow-up was significantly higher in patients treated by gastroenterologists. Further work is needed to establish quality metrics in endoscopic removal of EFBI. From our limited study it appears that increased effort could be placed on ensuring patients obtain appropriate post-procedure education and follow-up.