First Year Fellows Endoscopy Course (August 7 - 8) | 2022-11-Foreign

11-Foreign_Body Management
Pdf Summary
The management of foreign bodies and food impactions is important in preventing complications and ensuring patient safety. It is estimated that 1500 people die annually due to foreign bodies in the GI tract, with the pediatric age group being the most at risk. Other high-risk groups include edentulous adults, those with eosinophilic esophagitis, alcoholics, prisoners, and psychiatric patients. <br /><br />The majority of ingested foreign bodies pass spontaneously (80-90%), while about 10-20% require endoscopic removal and about 1% require surgery. Complications of foreign body ingestion can include perforation, mediastinitis, lung abscess, fistula, and aspiration. Therefore, it is important to consider the possibility of multiple foreign bodies.<br /><br />Commonly ingested objects include coins, toys/magnets, crayons, ball point pen caps, batteries in children, and food impactions (meat, bones), dentures, and sharp objects in adults. Patients may present with symptoms such as dysphagia, neck tenderness, odynophagia, hypersalivation/inability to tolerate oral secretions, regurgitation, and abdominal pain. Physical examination and radiologic imaging, such as chest X-ray or CT, can help determine the location and presence of complications.<br /><br />Endoscopy should be performed within 12-24 hours to prevent complications in esophageal foreign bodies. Urgent endoscopy may be needed for patients in respiratory distress/compromise, experiencing pain, unable to handle secretions, or with sharp objects below the upper esophageal sphincter. Airway protection is important, especially in children, mentally ill patients, and uncooperative patients.<br /><br />Tools commonly used for endoscopic removal include grasping forceps, polypectomy snare, retrieval net/basket, foreign body hood, and overtube. In the case of esophageal food bolus impaction, the bolus can be pushed into the stomach carefully, while assessing the cause of obstruction and angle at the gastroesophageal junction. Food can be extracted through the mouth using various tools, and follow-up endoscopy may be needed for assessment of strictures.<br /><br />Sharp and pointed foreign bodies, such as toothpicks, nails, needles, razor blades, pens, safety pins, and dental appliances, should be removed before they pass through the stomach. Button batteries require urgent endoscopic removal if in the esophagus to prevent rapid injury. The management of multiple magnets depends on their location and symptoms.<br /><br />In summary, recognizing indications for urgent endoscopy, contraindications for endoscopic retrieval, and condition-specific considerations such as eosinophilic esophagitis are important for the successful management of foreign bodies and food impactions. Planning the strategy, being familiar with available equipment, and protecting the airway are key in ensuring patient safety.
Keywords
foreign bodies
food impactions
complications
patient safety
endoscopic removal
esophageal foreign bodies
sharp objects
airway protection
multiple magnets
eosinophilic esophagitis