First Year Fellows Endoscopy Course (August 5 - 6) | 2022-11-Foreign

11-Foreign_Body Management

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This document provides an overview of the management of foreign bodies and food impactions in the GI tract. It discusses the timing and location for endoscopy, as well as the types of high-risk objects and the choice of accessories for removal. Airway protection during procedures is also emphasized. The document highlights that about 1500 people die annually from foreign bodies in the GI tract, with the highest risk among pediatric patients, edentulous adults, and certain patient populations such as alcoholics, prisoners, and psychiatric patients. The outcomes for ingested foreign bodies are described, with 80-90% passing spontaneously, 10-20% requiring endoscopy for removal, and about 1% requiring surgery. Complications such as perforation, mediastinitis, lung abscess, fistula, and aspiration are also mentioned. Commonly ingested objects for children and adults are identified. The symptoms, physical examination findings, and radiologic imaging for foreign bodies are outlined. The document recommends avoiding contrast studies that may interfere with endoscopy and suggests using chest X-ray and/or chest CT for suspected perforation. Anatomical landmarks where foreign bodies can impact are listed. Indications for endoscopic removal of foreign bodies and urgent endoscopy are provided. Airway precautions are discussed, with different approaches for children, mentally ill patients, uncooperative patients, and most cooperative adults. The tools and accessories used for endoscopic removal of foreign bodies are described. Specific considerations are given for esophageal food bolus impaction, eosinophilic esophagitis, sharp and pointed foreign bodies, button batteries, and multiple magnets. Complications associated with these objects are also mentioned. The document concludes with a summary that highlights the need to recognize indications and contraindications for endoscopy, plan strategies before the procedure, be familiar with available equipment, and protect the airway by choosing appropriate sedation.

Keywords

foreign bodies

food impactions

GI tract

endoscopy timing

high-risk objects

airway protection

complications

ingested objects

indications for endoscopic removal

airway precautions