Reasonable algorithm of the management of esophageal foreign bodies

Abstract

Objective To investigate the clinical characteristics of esophageal foreign bodies, and summarize the reasonable algorithm of the management. Methods The clinical records of 199 consecutive patients with esophageal foreign bodies ingestion treated in Shanghai Chest Hospital between January 2008 and December 2013 were retrospectively collected. According to the findings of clinical signs, radiological images and other examinations, the patients were classified into two types, and were treated following a settled algorithm. Type 1 was defined as no or restricted esophageal perforation, and was sent to esophagoscopy first. Type 2 was defined as non-restricted esophageal perforation, and was sent to surgery first. The clinical outcomes of these two types were collected. The age, gender, duration of impaction, sharpness of esophageal foreign bodies and localization of entrapment were compared between endoscopy group and surgery group. Results A hundred and seventy-six patients came to hospital within 48 h after impaction, while 23 patients did after 48 h. Esophageal foreign bodies were confirmed in 196 patients through esophagoscopy or surgery. The most frequent type of esophageal foreign bodies was the bones of fish, domestic fowls and animals (116 cases, 59.1%), and the secondary type was the dentures (31 cases, 15.8%). The frequency of location of entrapment was 61.2%(120 cases) at the first esophageal physiological narrow, 32.2%(63 cases) at the second and 6.6%(13 cases) in the lower esophagus. A hundred and seventy-nine patients were classified as type 1, among whom 175(97.8%) were successfully treated only with esophagofiberoscopy, 3 were sent to surgery later after failed retrieval of esophageal foreign bodies or complications after retrieval, and the other 1 died of septic shock following severe mediastinitis. Twenty patients with non-restricted esophageal perforation were treated by surgery first. As for the surgery group, the percentages of impaction duration longer than 48h and sharp type of esophageal foreign bodies were 30.4%(7/23) and 100%, respectively, both of which were significantly higher than the endocopy group(9.1%, 16/176) (χ2=9.066, P=0.003; χ2=4.799, P=0.028). Conclusions Impaction duration longer than 48 h and sharp esophageal foreign bodies are significant risk factors for surgical interference. With rational anesthesia, esophagofiberoscopy can safely retrieve most esophageal foreign bodies. The therapeutic ending of esophageal foreign bodies ingestion is not the retrieval of the esophageal foreign bodies but more importantly is the quick assessment and cure of the esophageal injury after esophageal foreign bodies ingestion by following a reasonable algorithm. Key words: Esophageal foreign bodies; Esophageal injuries; Esophagoscopy