Esophageal Foreign Body Research Articles

Systematic review of rigid and flexible esophagoscopy for pediatric esophageal foreign bodies

BackgroundEsophageal foreign body (EFB) is a common presentation in pediatric hospitals. Rigid and flexible esophagoscopy are both primary modalities used for EFB removal. By systematically reviewing the literature, we sought to assess success and complication rates of both rigid and flexible esophagoscopy in pediatric EFB retrieval. MethodsA systematic search of the literature was performed in MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, CINAHL. Two authors independently reviewed 74 abstracts and included studies that documented success rates of flexible and rigid esophagoscopy for EFB retrieval. The certainty and quality of the overall body of evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development and Evaluation approach. ResultsFive retrospective chart reviews published between 1993 and 2016 identified 955 patients with a mean age of 4.2 (range 3.2–5.3 years). Foreign bodies were localized to the upper esophagus in 69.6%, middle esophagus in 13.0% and lower esophagus in 11.5%. Coins (82.1%) and food boluses (8.5%) comprised the majority of EFB. The success rate of foreign body retrieval was 95.4% with rigid esophagoscopy and 97.4% with flexible esophagoscopy. Complication rates were 2.4% for rigid esophagoscopy and 3.4% for flexible esophagoscopy. Rates of successful foreign body retrieval (odds ratio [OR] = 1.9 [95% CI 0.9–3.8; p = 0.07]) and complications (OR = 0.9 [95% CI 0.3–2.3; p = 0.79]) were not significantly different across modalities. There were no mortalities in any of the studies analyzed. ConclusionFlexible and rigid esophagoscopy are equally safe and effective for the retrieval of EFB in children. Otolaryngologists, gastroenterologists, and pediatric general surgeons can be consulted for foreign body retrieval depending on institutional policies and resource availability.

Successful endoscopic extraction of a missing proximal esophageal foreign body.

Successful endoscopic extraction of a missing proximal esophageal foreign body.

Esophageal Perforation in a Patient with Smith-Lemli-Opitz Syndrome

Smith-Lemli-Opitz syndrome (SLOS) is a rare syndrome caused by an inborn error of cholesterol metabolism secondary to a deficiency in the 7-dehydrocholesterol (7-DHC) reductase enzyme leading to hypocholesterolemia. A broad spectrum of clinical manifestations can have significant surgical and anaesthetic implications. Patients exhibit growth retardation, microcephaly, congenital heart disease and moderate to severe intellectual disability. Distinctive facial features including micrognathia, cleft palate and prominent incisors can lead to difficult airway management [1]. We present the case of a 16-year-old female with SLOS who developed an esophageal perforation following esophageal foreign body retrieval. Anaesthetic and surgical considerations in a patient with SLOS are discussed.

Frequency and Complications of Button Battery Cell as Foreign Body in Esophagus

Background: Foreign bodies are commonly impacted in the esophagus and button battery cells are one of the foreign bodies, which could be found. Objective: To find out the frequency and complications of button battery cell intake, among the cases of esophageal foreign bodies. Methodology: A cross-sectional study was conducted at the Department of Otorhinolaryngology of Nishtar Hospital, Multan, from December 2017 to November 2018. After getting anesthesia fitness, rigid endoscopy was performed to remove the foreign body in 250 cases. Nasogastric intubation was done kept in place for two weeks before starting oral sips. Antibiotics, steroids, and H2 receptor antagonists were given in cases of the battery cell. Age, type of foreign body, endoscopic findings, level of impaction, and type of complication were documented. Data was put in SPSS 23 and analyzed. Results: Out of 250 cases of foreign bodies in the esophagus, there were 50 (20%) cases of button battery intake, with an age range from 8 months to 8 years. The delay between ingestion and presentation ranged from 3 hours to 28 days. Out of 50 cases of button battery in the esophagus, 20 (40%) developed some complications; One patient developed tracheo-esophageal fistula, 5 developed strictures, 1 developed hydropneumothorax, 2 developed vocal cord paresis, 1 developed stricture as well as aspiration pneumonia and 10 developed minor complications while one patient expired. Conclusion: This study showed that the button battery in the esophagus is quite common in children, which warrants the prompt identification and removal of impacted battery to avoid complications.

History and radiographic findings as predictors for esophageal coins versus button batteries

ObjectiveTo determine if clinical history and radiographic findings are reliable predictors for coin versus button battery in children presenting with esophageal foreign bodies to accurately guide decision making regarding the urgency of removal. MethodsA retrospective chart review was conducted in a single pediatric tertiary care center of all children who presented with suspected coin or button battery esophageal foreign body ingestion from 2017 to 2019. Patients with documented surgical removal, completed consultation notes, and available radiographic studies were included. Descriptive statistical analysis was performed and predictive characteristics of the diagnostic tests were calculated. Results139 patients met inclusion criteria for the study. Of 5 patients who had esophageal button batteries removed, clinical history was concerning for button battery in 2; accuracy of 12.35%. However, radiology reports suggested a battery in all 5. The negative predictive value for radiology alone for diagnosis of button battery was 97% with 81% accuracy. The clinical history for coin foreign body was accurate in 85.28% while radiography was 87% accurate. Wait time on average for all coin foreign body cases was 6.3 h. Day cases waited on average 5.5 h while after-hours cases waited a statistically significantly longer 7.5 h (p = 0.006). ConclusionButton batteries, while clinically important emergencies, are rare esophageal ingestions. Radiography has a strong negative predictive value for button battery. Children whose radiographic studies do not demonstrate concern for button battery could be considered for delayed elective removal. This could allow children to complete a period of observation at home, thereby reducing prolonged in-house wait times prior to operative removal.

Analysis of clinical features of 63 cases of esophageal foreign body complicated with pulmonary infection

Analysis of clinical features of 63 cases of esophageal foreign body complicated with pulmonary infection

Retained gastrostomy bumper resulting in esophageal fistula and spinal osteomyelitis

Abstract Background We report a case of spinal osteomyelitis and fistulous tract between the esophagus and prevertebral soft tissues secondary to an esophageal foreign body. This resulted from a retained gastrostomy bumper that broke on removal of the tube seven years earlier. Case presentation A 9-year-old male with Troyer Syndrome and developmental delay presented to his pediatrician with the refusal to bear weight and new onset torticollis, and was referred to our institution for further evaluation. He was admitted for further workup due to concern for a neurological process. Imaging revealed osteomyelitis of T3/T4 and inflammatory changes in the posterior mediastinum with possible communication with the esophagus. His gastrostomy tube (GT) was converted to a gastrojejunal tube (GJT) for post-pyloric feeding. He acutely worsened after this procedure, and further radiographic imaging revealed a retained foreign body in the esophagus. An upper endoscopy was subsequently performed with snare removal of the object, identified as the bumper of a previous gastrostomy tube. This esophageal foreign body caused esophageal erosion leading to creation of a fistulous tract with nidus for infection spread posteriorly. The patient underwent prolonged treatment for the infection, with improvement in his presenting symptoms, and eventually resumed gastrostomy feeding. Conclusion Retained foreign body following gastrostomy removal, while typically does not warrant further investigation, may present with significant sequelae if retained especially in children with developmental delay and feeding difficulties.

Oesophageal foreign bodies in cats: Clinical and anatomic findings.

BackgroundAnatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through the oesophagus. This study has two goals 1) to assess feline oesophageal foreign bodies in feline patients using physical, radiologic and endoscopic examination and, how their location influences treatment plans and complications. 2) How the anatomical sharp angle of the oesophagus contribute to foreign body lodgement. Thirty-five cats were enrolled in this study; 30 of them were clinically ill, and five cats were used for anatomical study.ResultsCats with clinical signs underwent complete clinical and radiologic examination. Endoscopy was performed in only five cases. The site with the highest occurrence of foreign body lodgement was the oesophageal entrance, caudal to the pharynx (63.3%), followed by the thoracic inlet (26.7%) and the mid-cervical region of the oesophagus (10%). Two types of foreign bodies were identified: sewing needles (25/30) and bone (5/30). Radiography was able to identify the location and nature of the foreign body in all 30 affected cats. Therapeutic regimens were applied according to the nature and location of the foreign body and any associated complications. Removal of the foreign body was achieved using Rochester pean artery forceps in 17/30 cases, using full surgical intervention in 8/30 cases, and during endoscopy in 5/30 cases.ConclusionThe results suggest that the location of the foreign body is strongly related to combination of consumed foreign body type and anatomic features of the cat oesophagus. The feline oesophagus has a variety of sharp angles that facilitate the entrapment of rigid linear and angular foreign bodies. Radiographic imaging remains the most frequently used diagnostic modality for determining the lodgement site and nature of radiopaque foreign bodies. Over all complication rate was low (6/30).

Surgical management of oesophageal foreign body syndrome in an Indian ring-neck parakeet

Surgical management of oesophageal foreign body syndrome in an Indian ring-neck parakeet

Esophageal foreign body removal using endoscopy in cat

A 10-months-old cross long hair cat named Casper with clinical symptom of vomiting mixed with slimy cat feed was referred to Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Bogor Agricultural University to endoscopy examination and therapy. The owner believed that Casper ate a 5 cm long sewing needle a few days earlier. The history and physical examination were examined at DNA Clinic with symptoms of lack of appetite and becoming quieter and calmer. Radiogram showed the needle was in thorax area with a vertical needle penetrating the esophageal wall. Removal of the needle and observation of the esophagus area were done using endoscopy under general anesthesia. Using endoscopy, it was known that the needle was swallowed along with the sewing thread with position of all needles penetrating the esophagus wall and leaving a small amount of thread on the lumen. The needle was pulled back to the esophageal lumen by pulling the remaining thread and then both needle and the thread were pulled back out using an alligator grasping forceps that used through working channel. Therapy given after endoscopy was antibiotics and anti-emetics.

Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

National trends in healthcare outcomes and utilization of endoscopic and surgical interventions in patients hospitalized with esophageal foreign body and food impaction.

The incidence and number of emergency room visits for esophageal foreign body and food impaction (EFB) are on the rise. However, its impact on the rate of inpatient admissions, utilization of endoscopic and surgical interventions, and healthcare outcomes is poorly understood. We conducted a study to analyze these outcomes using the national inpatient sample (NIS) database. Data on all adult patients (≥18years) admitted with EFB was extracted from the NIS database from 1998 to 2013. The temporal trends in discharge rates as well as in length of stay (LOS), hospital charges, and in-hospital mortality rates were assessed by linear and polynomial regression. Average age, gender, and race of inpatients with EFB were not significantly different between 1998 and 2013. The rate of EFB admissions increased significantly from 1998 to 2005 followed by a decline thereafter (p= 0.01). LOS and hospital charges significantly increased by 0.02days/year (p= 0.015) and $1,547/year (p< 0.001), respectively. There was a trend towards less utilization of overall esophagogastroduodenoscopy (EGD) over the last decade with significant lower use of EGD within 24hours in 2013 as compared to 1998 (p= 0.026). The rates of surgical intervention and inpatient mortality did not change significantly over the study period. The rate of inpatient admissions for EFB is on the decline in recent years, suggesting the modern-day practice of cost-effective medicine. Hospitalization costs for EFB have increased, whereas rates of surgical intervention and inpatient mortality have not changed significantly over the study period.

An apple a day won't keep the doctor away: presentation, treatment, and outcome in pediatric apple aspirations.

Foreign body (FB) aspiration is a frequent and preventable source of morbidityand mortality, especially in children under 4 years of age. Few comprehensive studies exist on presentation and outcome of apple aspirations in children. In a retrospective analysis of bronchoscopy records of a tertiary medical care center from January 2007 to August 2019, we identified pediatric cases of suspected apple aspirations. A total of 11 suspected apple aspirations were identified (observation time 12.7 years, n = 5858 bronchoscopies, n = 226 interventions due to suspected FB aspirations in total). The mean age of patients was 24 months (standard error mean, 7 months; range, 8-83 months), and 6 out of 11 cases (55%) were male. Bronchoscopy confirmed apple aspiration in n = 6/11 cases (55%). In n = 2/11 cases (18%), a bite of the apple was located in the esophagus causing significant tracheal narrowing, and in n = 3/11 cases (27%), no FB was found. In all cases of airway FB identification, extraction was successful. Hypersalivation was associated with esophageal FB location, whereas persistent cough, stridor, or dyspnea were associated with airway FB location. Outcomes ranged from complete reconstitution 1 day after bronchoscopy in most cases to hypoxemia with severe brain damage in one patient. This analysis shows that apple aspirations are not entirely uncommon in children and may lead to disastrous complications. Typical signs of airway location are persistent cough, stridor or dyspnea, whereas hypersalivation may point toward an esophageal location. In each case of suspected apple aspiration, timely bronchoscopy with possible FB extraction should be performed by an experienced team.

English

English

Diagnostic Accuracy of Lateral Neck Radiography for Esophageal Foreign Bodies in Adults.

OBJECTIVE. The objective of our study was to evaluate the accuracy of signs on lateral neck radiography for the assessment of patients with suspected esophageal foreign bodies (FBs). MATERIALS AND METHODS. This retrospective study was conducted of 235 adult patients between January 2012 and December 2017. Group 1 was composed of 95 patients with esophageal FBs, and group 2 was composed of 140 patients without esophageal FBs. Four signs on lateral neck radiography were recorded in both groups: presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness. The prevertebral thickness was also evaluated in three groups of patients categorized by patient age: 19-29 years old, 30-59 years old, and 60 years old or older. RESULTS. The accuracy of the presence of abnormal radiopaque density, presence of abnormal air column lucency, loss of cervical lordosis, and increased prevertebral soft-tissue thickness was 84.3%, 66.8%, 54.0%, and 60.9%, respectively. Combined two signs of presence of radiopaque density with air column lucency provided the highest accuracy, 90.6%. The prevertebral thickness at C6 of group 1 was 14.28 ± 3.19 mm (mean ± SD), and the prevertebral thickness at C6 of group 2 was 13.34 ± 2.54 mm (p = 0.018). CONCLUSION. Lateral neck radiography is helpful for the initial evaluation of patients with suspected esophageal FBs. The presence of radiopaque density or air column lucency provided the highest practical diagnostic value. Loss of cervical lordosis, as a single diagnostic sign, did not seem to provide a diagnostic advantage. Despite the variations in values for the three age groups, clinicians should be alert regarding increased prevertebral thickness at C6 especially when it is more than 20 mm.

Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review

Introduction Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion.&#x0D; MethodsThis was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up.&#x0D; ResultsOur final sample size was 11 and all cases were &lt;15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications.&#x0D; ConclusionButton battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve.

Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review

Introduction: Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion. Methods: This was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up. Results: Our final sample size was 11 and all cases were &lt;15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications. Conclusion: Button battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve.

Symposium 4 “Airway and Esophageal Foreign Body Treatment Techniques to Convey to Future Generations” —Introduction

Symposium 4 “Airway and Esophageal Foreign Body Treatment Techniques to Convey to Future Generations” —Introduction

Innovation in Esophageal Foreign Body Extraction by Gastrointestinal Endoscopy

Innovation in Esophageal Foreign Body Extraction by Gastrointestinal Endoscopy

Case report of uncommon esophageal foreign body: goat’s eye

&lt;p&gt;Foreign bodies of upper aero digestive tract are commonly dealt by an otolaryngologist. We have seen a variety of foreign bodies of esophagus, varying from irritants to non irritants, sharp to big blunt objects which almost always require intervention. An elderly man presented to us with acute onset of dysphagia after ingesting meat. On flexible esophagoscopy, it was found to be an uncommon foreign body of the esophagus which is goat’s eye. We believe this is the first of its kind to be reported in the literature. He had consumed the whole eyeball with the belief that it would improve his vision. Even in today’s era such weird customs and practices prevail in many remote places. Health education should be advocated in target areas to bring about a change in the mindset of people. &lt;/p&gt;