Upper Gastrointestinal Foreign Bodies - A Five Year Experience from a Cosmopolitan Hospital in UAE

Abstract

Purpose: UGI Endoscopy is a useful tool to manage the extraction of inadvertent ingestion of foreign bodies from upper gastrointestinal tract. We report the cases from NMC Specialty Hospital, UAE over a span of five years from 2003-2008. Methods: All patients who underwent endoscopy for attempted extraction of ingested foreign bodies were reviewed. In cases where endoscopy was not indicated patients/parents were counseled for the same and those cases where extraction was not attempted, were excluded. Endoscopies were performed under GA in children and conscious sedation in adults. Accessories were chosen after testing their grip on similar objects before the procedure. Fluoroscopy was employed to facilitate localization during procedure. Results: The summary of all cases is shown in the table below. Swallowed coins and lead batteries were the most common foreign bodies found in the pediatric population. Fluoroscopy was utilized in locating the objects buried in the luminal food residue. The Rat Tooth Forcep simplified the extraction of coins while Polypectomy Snare secured firm grip on the slippery button batteries. Custom pins were 1.5 inch long with ball shaped plastic heads and sharp tips. Women use them to secure head scarf in gulf countries. In all cases accidental swallowing happened when patients were holding them between teeth while adjusting their scarf. Partial mucosal penetration by the pin was observed in one patient. She was initially sent back from emergency as an erect AXR was negative. But later on a supine AXR showed the pin when patient returned because of persistent discomfort. Pins were easily extracted by holding the sharp end with simple biopsy forceps. Polypectomy snare was also useful in doubling up of sharp edges of a swallowed prescription medicine with intact wrapper which was stuck across on both sides of the esophagus. Another potentially hazardous extraction of a 5 cm long denture, because of larger size and hard nature was safely achieved with the use of an over-tube. Extraction of a large and hard gastric bezoar partially imbedded in gastric mucosa after failed attempts to crush with a mechanical lithotripter, was achieved with surgery.Table: [1406] Types of foreign bodiesConclusion: A supine AXR is important to diagnose ingested radio-opaque foreign bodies. Fluoroscopy helps in locating non-visualized foreign bodies buried in luminal content. Thoughtful pre-procedure selection of endoscopic accessories simplifies the extraction of various upper GI foreign bodies. Over-tube facilitates safe extraction of large objects by diffusing the shear force over the esophageal wall. Non-crushable hard and large objects require surgical removal.