First Year Fellows Endoscopy Course (July 28-29) | 2023-11-Foreign

11-Foreign_Body Management

Pdf Summary

This document provides information on the management of foreign bodies and food impactions in the gastrointestinal (GI) tract. It discusses the timing and location of endoscopy, high-risk objects that can cause obstructions, choosing appropriate accessories for removal, and methods of airway protection during the procedure.<br /><br />Foreign bodies in the GI tract can be high risk, especially in certain populations such as pediatric age groups and individuals with certain conditions or behaviors like eosinophilic esophagitis, alcoholism, being edentulous, being in prison, or having psychiatric conditions. The majority of foreign bodies pass spontaneously, but some may require endoscopy or surgery for removal. Complications can include perforation, mediastinitis, lung abscess, fistula, and aspiration.<br /><br />Commonly ingested objects include coins, toys/magnets, crayons, ballpoint pen caps, batteries, and food impactions such as meat, bones, and dentures.<br /><br />Patients with foreign bodies may present with symptoms like dysphagia, neck tenderness, odynophagia, hypersalivation, regurgitation, and abdominal pain. Physical examination and radiologic imaging can help with diagnosis and determining the location of the object.<br /><br />The document also discusses the use of radiologic studies, avoidance of contrast studies that may interfere with endoscopy, and the impact of foreign bodies at narrowings in the GI tract.<br /><br />Endoscopic removal of esophageal foreign bodies should be done within 12-24 hours to prevent complications like airway compromise, perforation, and fistulas. Urgent endoscopy is indicated for respiratory distress, pain, inability to handle secretions, and sharp objects below the upper esophageal sphincter.<br /><br />Airway precautions should be taken, considering factors such as patient cooperation, comorbidities, and Mallampati score. Various tools like grasping forceps, retrieval nets, baskets, and hoods are used for the removal of foreign bodies.<br /><br />Specific considerations are discussed for esophageal food bolus impaction, eosinophilic esophagitis, and sharp and pointed foreign bodies. The document also mentions button batteries, magnets, and their potential complications, and provides a summary of key points to remember for the management of foreign bodies and food impactions during endoscopy.

Keywords

foreign bodies

food impactions

gastrointestinal tract

endoscopy

high-risk objects

accessories for removal

airway protection

pediatric age groups

eosinophilic esophagitis

alcoholism