Endoscopic management of foreign bodies in the upper gastrointestinal tract: Report on a series of 414 adult patients

Background and Study Aims: Ingestion of foreign bodies is a common occurren ce. Few papers in the literature report experience and outcome at tertiary centers. The aim of this paper is to report the management and the outcomes in 414 patients admitted for suspected ingestion of foreign body between M ay 1995 and December 1999. Methods: A plain radiographic film of the neck, chest or abdomen was obtain ed in the case of radiopaque objects, and in order to rule out suspected pe rforation: in such cases a computed tomography (CT) study was also performe d. All patients were asked to give their informed consent, which was refuse d by three patients. Anesthesia was always used, either conscious sedation (86.8 %), or general anesthesia in the case of poor patient tolerance (13.2 %). All patients underwent an endoscopic procedure within six hours of adm ission. A flexible scope was used in all patients and a wide range of endos copic devices was employed. Results: Foreign bodies were found in 64.5 % of our patients. Almost all we re found in the esophagus. The types of foreign body were very different, b ut they were chiefly food boluses, bones or cartilages, dental prostheses o r fish bones. In three patients (1.1 %) it was impossible to endoscopically remove the foreign body, which was located in the cervical esophagus: all these three patients required surgery. No complications relating to the end oscopic procedure were observed, but 30.7% of patients had an underlying es ophageal disease, such as a stricture. Only eight patients required a secon d endoscopic procedure, performed by a more experienced endoscopist. Conclusion: Foreign body ingestion represents a frequent reason for emergen cy endoscopy. The endoscopic procedure is a successful technique which allo ws the removal of the foreign bodies in almost all cases without significan t complications. Surgery is rarely required.