Management Of Esophageal Foreign Bodies Research Articles

Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers.

This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Change in trend in the management of esophageal foreign bodies at University Hospital of Split

Uvod: Strana tijela jednjaka predstavljaju jedno od hitnih stanja koja su česta u otorinolaringološkoj praksi i kao takva predstavljaju izazov zdravstvenim djelatnicima. Glavni cilj ovoga istraživanja bio je prikazati smanjenje broja ezofagoskopija krutim ezofagoskopom zbog sumnje na strano tijelo, uz prikaz broja fleksibilnih ezofagogastroduodenoskopija (EGDS) učinjenih zbog sumnje na strano tijelo. Bolesnici i metode: Provedena je retrospektivna studija u koju je uključeno 855 ispitanika kojima je u KBC-u Split učinjena ezofagoskopija krutim ezofagoskopom ili fleksibilna EGDS zbog sumnje na strano tijelo tijekom razdoblja od 2001. do 2021. god. Prikupljeni podaci za bolesnike s Klinike za bolesti uha grla i nosa s kirurgijom glave i vrata uključivali su: dob, spol, datum obavljenog zahvata, prisutnost stranog tijela, vrstu stranog tijela, lokalizaciju stranog tijela, postojanje komplikacija i novootkrivenih medicinskih stanja. Za bolesnike s Odjela gastroenterologije dostupni su bili podaci za razdoblje od 2016. do 2021. god. Za usporedbu kategorijskih varijabli proveli smo hi-kvadrat test pri razini značajnosti od p<0.05. Rezultati: Na Klinici za bolesti uha, nosa i grla s kirurgijom glave i vrata učinjeno je ukupno 559 zahvata ezofagoskopije krutim ezofagoskopom, u razdoblju od 2001. do 2021.god. Od 2016. do 2021.god. učinjeno je 139 ezofagoskopija krutim ezofagoskopom. Od 2016. do 2021. god. na Odjelu gastroenterologije Klinike za unutarnje bolesti učinjeno je 296 fleksibilnih EGDS. Postoji statistički značajna razlika u broju zahvata fleksibilne EGDS i ezofagoskopije krutim ezofagoskopom u razdoblju 2016. do 2021.god.,p< 0.05 . Strano tijelo pronađeno je u 63% zahvata ezofagoskopije krutim ezofagoskopom. Ingestija stranog tijela češća je kod muškaraca. Medijan dobi ispitanika u Klinici za bolesti uha, nosa i grla s kirurgijom glave i vrata bio je 45,5 godina. Najveći broj ispitanika u pedijatrijskoj populaciji su predstavljala djeca do druge godine života. Najzastupljenija dobna skupina odrasle dobi bili su bolesnici u šestom desetljeću života. Najčešća razina opstrukcije u više od četvrtine bolesnika bilo je prvo suženje jednjaka. Kod četvrtine bolesnika sa stranim tijelom najčešću vrstu stranog tijela predstavljao je bolus hrane. Zaključci: Ovim je istraživanjem potvrđena promjena trenda u pristupu rutinskom vađenju stranih tijela jednjaka tijekom razdoblja od 2016. do 2021. god., u kojemu je prva metoda izbora bila fleksibilna EGDS. Ezofagoskopija krutim ezofagoskopom ostaje i dalje metoda izbora kod bolesnika kojima se fleksibilnom endoskopijom ne uspije odstraniti strano tijelo prilikom sumnje na oštro strano tijelo, te kod stranih tijela na razini gornjeg sfinktera jednjaka ili hipofarinksa.

Therapeutic management of esophageal foreign bodies enclaved and complicated with esophageal perforation

Esophageal foreign bodies constitute a formidable chap­ter of pathology, especially due to the nature of the com­pli­ca­tions that may appear in the evolution of such cases, some even life-threatening. The block­age and even­tual en­cla­va­tion of a foreign body at the level of the eso­pha­gus can occur following the vo­lun­tary or involuntary in­ges­tion of various particles, or­ga­nic or inorganic, on a pre­viously healthy esophagus or on a pathological one, which presents stenoses of va­rious etio­logies. In the case of ag­gra­va­tion of the local si­tua­tion or in the conditions of a ne­glec­ted foreign body, the extension of the lesions leads to the appearance of eso­pha­geal perforation and cervical, tho­ra­cic or ab­do­mi­nal periesophagitis, with possible complications that are difficult to control, such as cervico-mediastinitis, which is a serious condition that en­dan­gers the patient’s life. The authors aim to discuss the case of a patient who presented to the clinic seven days after the ingestion of a fish bone, embedded in the upper part of the esophagus and com­pli­ca­ted with perforation of the esophageal wall. The clinical as­pects encountered, the difficulties of visualization and ex­trac­tion of the fo­reign body, as well as the par­ti­cu­la­ri­ties of therapeutic ma­nage­ment related to the therapeutic conduct applied to eso­pha­geal foreign bodies in general are presented, com­men­ted and emphasized. Rapid diagnosis, prompt surgical in­ter­ven­tion (endoscopically or, if necessary, through an external approach), immediate reaction in the event of com­pli­ca­tions and follow-up of the patient are essential for the successful resolution of such a pathology.

Esophageal foreign bodies: our experience

<p class="abstract"><strong>Background:</strong> The objective of this prospective study was to report our experience of presentation and management of esophageal foreign bodies at GMC Doda.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the department of ENT at GMC Doda from January 2019 to October 2022. During this time period 43 patients of foreign body ingestion were admitted in the department of ENT. Of the 43 patients 27 were male and 16 were female patients. 34 were children and 9 patients were adults. After doing through examination, plain radiograph was done on admission in all patients. Age appropiate rigid endoscope was used for foreign body extraction under general anaesthesia.</p><p class="abstract"><strong>Results:</strong> In children the coin was the most common type of foreign body (28 patients, 82.3%), with about 39% managed conservatively after overnight observation,as the coin passed on spontaneously. In adults chicken bone was the most common type of foreign body (5 patients, 55%). Upper esophagus (cricopharynx) was the most common site of foreign body impaction in both adults and pediatric patients. Rigid endoscope was used in all patients requiring intervention.</p><p class="abstract"><strong>Conclusions:</strong> Our study suggests that pediatric patients have higher incidence of foreign body ingestion as compared to adults. Management depends on the type of foreign body ingested as many can pass on spontaneously without requiring any invasive intervention. Also the rigid endoscope is a safe, effective and cheaper instrument that is used for removal of foreign body from esophagus.</p>

Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs.

To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs. 63 client-owned dogs. Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire. 54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified. Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs. Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]). Intraoperative complications occurred in 18 (28.6%) dogs, and 28 (50%) dogs had a postoperative complication. Postoperative complications were minor in 14 of the 28 (50%) dogs. Dehiscence of the esophagotomy occurred in 3 dogs. Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge. Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months). Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication. Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.

Migration of ingested sharp foreign body into the bronchus: a case report and review of the literature

BackgroundForeign body ingestion is a common emergence in gastroenterology. Foreign bodies are most likely to be embedded in the esophagus. The sharp ones may penetrate the esophageal wall and lead to serious complications.Case presentationA 72-year-old Chinese female was admitted to our hospital with a 4-day history of retrosternal pain and a growing cough after eating fish. Chest computed tomography scan indicated that a high-density foreign body (a fish bone) penetrated through the esophageal wall and inserted into the left main bronchus. First, we used a rigid esophagoscope to explore the esophagus under general anesthesia. However, the foreign body was invisible in the side of the esophagus. Then, the fiberoptic bronchoscopy was performed. We divided the fish bone, which traversed the left main bronchus, into two segments under holmium laser and removed the foreign body successfully. The operation time was short and there were no complications. The patient was discharged 1 week postoperatively and was symptom free even under a liquid diet.ConclusionsThere are several challenges in the management of this rare condition. We applied the technique of interventional bronchoscopy to the management of esophageal foreign body flexibly in an emergency. A surgery was avoided, which was more invasive and costly.

Management of Esophageal Foreign Body Using Endoscopic Approach: an Experience from Kathmandu Medical College Teaching Hospital

Background: Esophageal foreign body is a common otolaryngological emergency encountered in clinical practice. The cases with esophageal foreign body need prompt medical attention and appropriate endoscopic or surgical intervention. The type of foreign body varies in different age groups and the level of impaction also varies accordingly. The foreign body in upper esophagus can be removed with safer and easier non-surgical techniques.Objectives: The objective of this study was to determine the demography, management approach and outcome of esophageal foreign body cases presented to Kathmandu Medical College Teaching Hospital.Methodology: This is a prospective study conducted in Kathmandu Medical College Teaching Hospital. The data was collected from the medical records of cases that presented to Kathmandu Medical College Teaching Hospital with clinical diagnosis of esophageal foreign body from July 2013 to July 2017.Results: Out of 101 cases of esophageal foreign body, there were 57% cases of chicken bone, followed by 17% mutton bone and 12% meat bolus. Among all, 71% cases had endoscopic removal of foreign body within six hours of presentation and 29% had endoscopic removal of foreign body between six to twelve hours. The most common age group was fifth decade of life. One patient had post-operative mediastinitis.Conclusion: The endoscopic approach is the mainstay of management in foreign body esophagus and timely management leads to successful outcome.Journal of Kathmandu Medical College, Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 136-139

Western view of the management of gastroesophageal foreign bodies

The best modality for foreign body removal has been the subject of much controversy over the years. We have read with great interest the recent article by Souza Aguiar Municipal Hospital, Rio de Janeiro, Brazil, describing their experience with the management of esophageal foreign bodies in children. Non-endoscopic methods of removing foreign bodies (such as a Foley catheter guided or not by fluoroscopy) have been successfully used at this center. These methods could be an attractive option because of the following advantages: Shorter hospitalization time; easy to perform; no need for anesthesia; avoids esophagoscopy; and lower costs. However, the complications of these procedures can be severe and potentially fatal if not performed correctly, such as bronchoaspiration, perforation, and acute airway obstruction. In addition, it has some disadvantages, such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies. Therefore, in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

A New Trend in the Management of Esophageal Foreign Body: Transnasal Esophagoscopy.

(1) To analyze the outcomes of patients with esophageal foreign body managed by transnasal esophagoscopy. (2) To review the value of lateral neck X-ray. Case series with chart review. Tertiary referral center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Lateral neck X-ray was used for initial screening in patients suspected of having an esophageal foreign body between 2007 and 2013. Rigid esophagoscopy was used as standard for further investigations before July 2010 and transnasal esophagoscopy after July 2010. From January 2007 to June 2010, 43 patients who were suspected of having an esophageal foreign body under lateral neck X-ray received rigid esophagoscopy, 31 of whom were found to have an esophageal foreign body. From July 2010 to December 2013, 302 patients underwent transnasal esophagoscopy, and an esophageal foreign body was noted in only 52 of these patients. In the 302 patients who underwent transnasal esophagoscopy, the sensitivity and specificity of having an esophageal foreign body by lateral neck X-ray were 59% and 83%, respectively. The introduction of transnasal esophagoscopy has changed the diagnosis and management for an esophageal foreign body. Transnasal esophagoscopy is a quick and safe procedure that can be performed under local anesthesia. Transnasal esophagoscopy could replace lateral neck X-ray to become the initial screening procedure and a useful treatment for patients with an esophageal foreign body.

Endoscopic Management of Esophageal Foreign Bodies

Endoscopic Management of Esophageal Foreign Bodies

A New Trend in the Management of Esophageal Foreign Bodies: Transnasal Esophagoscopy

Objectives: (1) Retrospectively review esophageal foreign body (EFB) management. (2) Analyze the outcome of patients with EFB managed by either transnasal esophagoscopy (TNE) or rigid esophagoscopy. (3) Review the value of neck lateral view x-ray. Methods: We retrospectively reviewed the cases suspicious for EFB managed between January 2007 and December 2013. In each case, neck lateral view was used for initial screening and the cases suspected to have EFB underwent esophagoscopy, which was rigid before July 2010, and TNE after July 2010. Results: From January 2007 to June 2010, 43 patients received rigid esophagoscopy and 31(72.1%) of them were positive for EFB. From July 2010 to December 2013, 302 patients underwent TNE. EFB was noted in only 52 patients and in 36 (69.2%) patients, the EFB could be removed by TNE, while in the other 16 patients with large, or sharp EFB, or possibly perforated esophagus, the EFB could only be removed by rigid esophagoscopy. In the 302 patients that underwent TNE, the sensitivity and specificity of true EFB by neck lateral view x-ray was 59% and 83%, respectively. There is no major complication of mediastinitis or esophageal perforation in both groups. Conclusions: The introduction of TNE changes the diagnosis and management for EFB. TNE is a quick and safe office procedure under local anesthesia. Neck lateral view X-ray should not be a routine examination any more. TNE could replace neck lateral view X-ray to be the first screening procedure and also a useful treatment for patients with EFB.

Management of Esophageal Foreign Bodies: Experience in a Developing Country

The outcome of esophagoscopy for removal of suspected esophageal foreign bodies (EFBs) is dependent on the FB characteristics and the surgeon's experience. This study was conducted to review our experience and highlight challenges in the management of EFBs in a developing country. The value of radiologic signs in FB detection was also evaluated. We conducted a retrospective chart review of 131 patients: 58.8% males and 41.9% females aged 8 months to 64 years, treated for suspected EFBs in our institution over a 13-year period. Statistics were derived by univariate analysis Foreign bodies were found and retrieved in 118 cases. Coins were the predominant FB in children (35%), and bones (25%) and dentures (17%) were predominant in adults. Plain radiography was highly useful in detecting FBs in children (coins/metals 100%) but less so in adults (bones 25%, dentures 11%). Repeated esophagoscopy attempts were encountered more in patients with impacted sharp objects (85%) and were recorded significantly among trainee surgeons (p = 0.004). Open esophagotomy was carried out in 13 (10%) difficult cases. Major complications including two iatrogenic esophageal perforations and one death occurred following esophagoscopy by trainee surgeons. Rigid esophagoscopy is relatively safe and useful procedure in trained hands for removal of EFBs. Management of long-standing EFBs, dentures, and other sharp objects requires the skills of the most experienced members of the surgical team for a successful outcome. Open surgical treatment is unavoidable in cases of irretrievable esophageal FBs or in the presence of esophageal perforation.

Management of Esophageal Foreign Bodies, retrospective study.

Background: Foreign body impaction in the esophagus is a common problem. Our Objective is to draw conclusions from a retrospective over viewing a number of cases to assess current methods of management and to come out with recommendation from collected experience.Patient and method: A retrospective study of (62) patients admitted to the Department of Thoracic and Cardiovascular Surgery at Medical City Teaching Hospital from January 2002 to December 2004 with history of foreign body swallowing and impaction. Six patients excluded from the (62) patients after having negative esophgoscpic findings. On presentation, history about type and time of ingestion, associated signs and symptoms were recorded, x- ray was taken. Rigid esophagoscopy or direct laryngoscopy and Magill forceps has been used. After the procedure completion, type and site of the foreign body and state of esophageal mucosa at the site of impaction were recorded. Chest Xray done postoperatively in certain patients when we had peroperative findings of bleeding, suspicion of perforation. All patients except 2 were discharged within 24 hours after the procedure.Results: The results showed that the commonest age group was among children between 1-10 years (27) patients, and 77% of the patients presented with dysphagia as the most common presenting symptom, site of impaction mostly in upper third of esophagus 68%, and 68% of the FB were radiopaque. Types of the FB were versatile but 50% of them were metalic objects.Conclusion: Esophageal FB is a common problem especially among children; it requires urgent intervention because of its deleterious complications if left untreated.Suspecion is enough indication especially in children. Management requires good experience in using the appropriate tools like Magill forceps, which is safe and quick in good hands.

Endoscopic Management of Esophageal Foreign Bodies: A Single Center Experience

Endoscopic Management of Esophageal Foreign Bodies: A Single Center Experience

Protein energy malnutrition revealing an esophageal foreign body

It is not unusual for a foreign body to be swallowed and be lodged in the esophagus. It is however, very unusual for such a foreign body to remain lodged for a period of 8 months. This particular case, a 15-month-old male infant, is under focus because of the time length the foreign body remained in the esophagus without local complications, what is unusual is a protein energy malnutrition complication. The neck and chest X-ray permitted the foreign body identification. The management of esophageal foreign body requires a multidisciplinary approach among otorhinolaryngologist, radiologist and pediatrician.

Management of esophageal foreign bodies: experience of 90 cases

In Japan, there have been few recent reports of large-scale studies on the characteristics and optimal treatment of esophageal foreign bodies. We analyzed data on 90 patients diagnosed as having esophageal foreign bodies treated between April 2002 and August 2007. In children younger than 15 years (n = 13), the types of foreign bodies included coins (n = 9), food (n = 1), and other objects (n = 3), 12 of which were successfully removed without endoscopic procedures; in the remaining 1 case, the object advanced to the lower digestive tract spontaneously. In adults aged 15 years or older (n = 77), the types of foreign bodies included food-bolus impaction (n = 26), press-through packages (n = 18), fish bones (n = 14), dental prostheses (n = 13), and other objects (n = 6). The foreign bodies had advanced to the lower digestive tract in 4 patients at the time of flexible endoscopy performed under topical pharyngeal anesthesia. In 6 of the remaining 73 patients, the first endoscopic extraction was unsuccessful, and 5 of these cases involved dental prostheses. The mean maximal size of the dental prosthesis was significantly greater in patients in whom removal was unsuccessful than in those in which it was successful (5.8 versus 1.6 cm, respectively; P < 0.05). The procedures employed following unsuccessful endoscopy included thoracotomy (n = 1), laparotomy (n = 1), removal by forceps under direct vision (n = 1), and rigid (n = 1), and flexible endoscopy (n = 2) under general anesthesia. The majority of esophageal foreign bodies were successfully removed nonendoscopically in pediatric patients and endoscopically in adult patients. Endoscopic removal under topical pharyngeal anesthesia may not be indicated for patients who have swallowed large dental prostheses.

Esophageal foreign body as a cause of upper gastrointestinal hemorrhage: case report and review of the literature

Foreign body ingestion is a common complaint in the emergency department. Severe upper gastrointestinal (GI) hemorrhage is a rare complication of foreign body ingestion and is always considered to signal aortoesophageal fistula (AEF). We report a rare case of a 65-year-old man with upper GI hemorrhage caused by an ingested duck bone 10 days previously. Instead of AEF, massive erosion and edema were found in the esophagus, highlighting the potentially complex pathology of foreign body ingestion. A literature review of the recognized clinical features of esophageal foreign body is described. Some practical points and pitfalls in the management of esophageal foreign body are presented. For patients with a history of esophageal foreign body ingestion, the clinician must maintain a high index of suspicion and must endeavor to obtain a full history.

Management of Esophageal Foreign Body

Foreign body ingestion is a common clinical problem. Objects such as coin, safety pin, meat bolus, bone, denture, etc. are often ingested. They lodge in certain part of esophagus, which may be asymptomatic or develop some symptoms of esophagus or respiratory tract. Plain radiography is indicated for every patient with a known or suspected foreign body. It may appear as radiopaque or radiolucent images. A number of methods can be used to remove esophageal foreign bodies, including: observation, endoscopy, rigid esophagoscopy, Foley catheter extraction, bougienage and sometimes administration of LES relaxant or surgery. Application of those strategies is selected based on the type and location of foreign bodies. Five cases had been managed by different strategies, i.e. two cases were successfully managed by endoscopy; a case was managed through careful observation; another case was managed by pushing object into stomach using endoscopic approach; and the other case was fail when it was managed by Foley catheter but then it was successfully managed by rigid esophagoscopy at ENT Department. All of cases had been managed without any complication.

Esophageal foreign bodies: Types and techniques for removal

Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of object, time since ingestion, location of the object, and the likelihood of associated complications. Patients who have evidence of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased risk of complications. Button batteries are particularly injurious in the esophagus and should be removed immediately. Coins in the esophagus should also be removed; however, a brief period of observation is appropriate for coins in the distal esophagus, as some will pass spontaneously. Flexible endoscopy is the therapeutic modality of choice for most patients. The key principles for endoscopic management of esophageal foreign bodies are to protect the airway, to maintain control of the object during extraction, and to avoid causing additional damage. Endotracheal intubation is sometimes necessary, especially in younger children and those at higher risk for aspiration. The use of devices such as an esophageal overtube and a latex protector hood may facilitate safer extraction of sharp/pointed objects. Patients with food impactions usually require treatment of an associated structural lesion of the esophagus.

Cuerpos extraños esofágicos: nuestra experiencia en diez años

ObjetiveTo study the management of esophageal foreign bodies. Material and methodsA retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by an otolaryngology department for ten years. ResultsRigid esophagoscopy was performed for suspected foreign bodies in 46 patients (27 females, 19 males); age range 22 months to 88 years. In 40 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (33/82,5%). The most common type of foreign body was chicken bones in adults (17/42) and coins in children (2/4). Nine patients (all adults) had complications. ConclusionsDue to its low cost and morbility, flexible endoscopy is the first choice for managing esophageal foreign bodies. Rigid esophagoscopy is still an appropriate technique when flexible endoscopy fails or it is not possible.