Upper Gastro-Intestinal Foreign Bodies: Etiology and Patient Characteristics Based on a Single Center Experience

Abstract

Purpose: To retrospectively analyze our experience in patients with upper gastro-intestinal tract (UGIT) foreign bodies (FB). Methods: A list was generated from our endoscopy database of all the patients who had undergone esophagogastroduodenoscopy (EGD) between 01/01/2006 and 10/31/2009 for a presumed diagnosis of FB in the UGIT. Data were collected for demographics, clinical presentation, underlying medical history, EGD findings, and type of FB. Patients were grouped based on the age at the time of EGD: pediatric (0-21 years) and adult (>21 years). Adults were further sub-divided into 2 groups based on the type of FB: acute food bolus obstruction (AFBO) and unusual/sharp objects (USO). Results: Demographics: A total of 73 endoscopic procedures were performed in 61 patients; 44 (72.1%) were males. Mean age was 39.3 (range: 1-92 years). There were 17 (28%) pediatric subjects, 26 (42.6%) adults with AFBO and 18 (29.4%) adults with USO; this latter group had 30 presentations. Pediatric Patients with FB: Mean age was 5.6 (range 1-16 yrs). Coins comprised the majority (80%) in younger children (0-5 years) and 28% in the older children (6-21 years). Other FB included batteries, beer bottle cap, pin, and fruit seed. There was one EGD failure due to impacted FB at the crico-pharyngeus; this was succesfully removed in the operating room by an ENT surgeon. Patients with AFBO: Mean age was 56 (range 22-92 yrs). Esophageal biopsies were obtained in 12 (46.1%) patients. Biopsy rates for the years 2006-2007 and 2008-2009 were 5/14 (35.7%) and 7/9 (77.7%), respectively. Esophageal pathology was found in 14 (53.8%) cases, as shown in the table. Of note, all 3 patients (11.5%) with eosinophilic esophagitis (EoE), were adult males under the age of 40. There were no EGD failures or complications. Patients with USO: Mean age was 47 (range 27-69 yrs). Underlying mental disorder was present in 8/18 (44.4%) and in all 5 patients (27.7%) with recurrent USO ingestion. Protective measures were used in two instances for the removal of a razor blade (hood) and chicken bone (intubation). There were no EGD failures or complications. Conclusion: The most common FB was AFBO in adults and coins in children. Underlying esophageal pathology is often seen in adult patients with AFBO. USO ingestion and repeated presentations are more common in patients with underlying mental disorders. Endoscopic management of FB in UGIT is safe and highly successful.Table: Underlying esophageal pathology found on EGD in AFBO group