Rigid esophagoscopy in the managment of esophageal foreign bodies

International Journal of Head and Neck Surgery

Background: Foreign body (FB) ingestion and impaction in the esophagus constitute an important cause of morbidity and mortality worldwide. One-third of foreign bodies retained in the gastrointestinal tract are present in the esophagus and mostly in children require endoscopic removal with rigid esophagoscopy. Aims and objectives: This study seeks to highlight the challenges in the management of esophageal FB using rigid esophagoscopy. It will also evaluate the outcome of management. Their management depends on the anatomic location, shape, size of the foreign body, and duration of impaction. Materials and methods: This was a retrospective study of 60 patients with confirmed esophageal foreign bodies that were managed in the ENT department of SCL Hospital, NHL Medical College, Ahmedabad, from January 2016 to June 2018. Demographic and clinical data were documented, and simple statistical tables were used to illustrate the data. Results: The data of 60 patients were retrieved from ENT emergencies. Fifty (83.33%) patients had radiologic confirmation of foreign bodies in their esophagus, and 10 (16.67%) were further confirmed during esophagoscopy. There were 35 (58.33%) males and 25 (41.67%) females with male:female ratio of 1:1.4. The age range was 1-70 years with a mean of 35 ± 6.88 years. Majority of the foreign bodies, 50 (83.33%), were impacted in the cricopharyngeal sphincter of the esophagus. Dentures ranked highest among the adult population, 15 (25%) cases, while coins ranked highest in the pediatric populations, 20(33.33%) cases. Six (10%) cases presented to the hospital after 72 hours. Complications occurred in 5 (8.33%) cases. Conclusion: The management of impacted esophageal foreign bodies with rigid esophagoscopy was safe, reliable, and an effective procedure despite its challenges.

2021

Introduction: Foreign body (FB) ingestion and impaction in the esophagus constitute an important cause of morbidity and mortality worldwide. One-third of foreign bodies retained in the gastrointestinal tract are present in the esophagus and mostly require endoscopic removal with rigid esophagoscopy. Objectives: This study seeks to highlight the challenges in the management of esophageal FB using rigid esophagoscopy. It will also evaluate the outcome of management. Their management depends on the anatomic location, shape, size of the foreign body and duration of impaction. Materials and Methods: This was a retrospective study of randomly selected 60 patients presented in ENT emergencies with confirmed esophageal foreign bodies and were managed in the ENT department of SCL Hospital, NHL Medical College, Ahmedabad, from January 2016 to June 2018. Demographic and clinical data were documented and simple statistical tables were used to illustrate the data. Results: Fifty (83.33%) patient...

World Journal of Surgery, 2012

Background 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. Methods 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 Results 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. Conclusions 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.

Journal of the Faculty of Medicine, 2011

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.

European journal of …, 2002

Objective: A retrospective study was conducted in 400 patients with esophageal foreign bodies (EFB) to assess characteristics of EFB and methods of treatment. Methods: From 1962 through 1998, 400 patients with EFB were treated in our department on an emergency basis. There were 202 men (50%) and 198 women (49.6%) ranging in age from 1.5 to 95 years. The main symptoms patients complained of were difficulty in swallowing and pain. Detailed anamnesis, oropharynx and hypopharynx examination and finally radiological examination were the diagnostic tools. The location of the FB was in the cervical esophagus in 57% of cases, in the thoracic one in 26% and at the cardioesophageal junction in 17%. The most common objects found were bones, morsels, coins and needles. Results: The treatment consisted of rigid esophagoscopy under general anesthesia in 343 (85.7%) of our cases. In 57 cases (14.3%) other means such as flexible esophagoscopy, Fogarty or Foley catheters and bougienage turned to be very useful. Only 12 patients (3%) were led to surgery because either extraction was impossible or perforation was present. No major complications occurred in the surgical group, whereas in the group of rigid esophagoscopy, there was one iatrogenous esophageal perforation that presented with empyema thoracis successfully treated. Finally, there was a case of an aortoesophageal fistula with mortal outcome perioperatively. Conclusions: (1) Esophagoscopy is a reliable method in the treatment of EFB impaction. (2) Alternative methods such as bougienage, etc., can be used only in selected cases with smooth foreign bodies. (3) Surgical treatment is unavoidable in cases of irretrievable EFB or esophageal perforation.

Objective: The aim of the study was to evaluate the management of foreign bodies in the esophagus and to determine the association with socioeconomic status. Methods: This cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose. Results: The average age of the patients was 10.38 years; 29 cases (85.2%) were in children under 12 years. There were 18 females (52.9%) and 16 males (47.1%). Thirty patients (88%) presented with a history of dysphagia, and 25 (73.6%) had vomiting. The site of impaction was the post-cricoid region in 22 patients (66%), the lower esophagus in 5 (15%), the mid-esophagus in 4 (13%), the posterior pharyngeal wall in 1 (3%) and the pyriform fossa in 1 patient (3%). Coins were the most common foreign body (61.8%). Socioeconomic analysis showed that 18 patients (52.9%) were in the low socioeconomic class, 12 (35.3%) in the middle class and 4 (11.8%) in the upper class. Conclusion: The presence of a foreign body in the esophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families.

Asian Journal of Surgery, 2017

Background: Esophageal foreign bodies (EFBs) are a relatively common clinical problem in pediatric patients. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. This study was conducted to review our experience in managing esophageal foreign bodies in pediatric patients, with an emphasis on the management and outcomes of complicated cases. Methods: Between March 1995 and March 2013, the records of all children up to the age of 12 years who were admitted to King Khalid University Hospital, Riyadh, Saudi Arabia, with a final diagnosis of EFBs were reviewed. The medical records were analyzed with respect to demographic data, presenting symptoms, workup investigation, management, complications, and outcomes. Results: Seventy patients were identified (38 boys and 32 girls). The ages ranged from 5 days to 12 years (mean: 4.4 years). Fifty-three (75.7%) patients presented within 24 hours. Thirteen (18.6%) patients had underlying predisposing factors. The most common EFB, found in 30 (42.8%) patients, was a coin. Witnessed ingestion of a FB was documented in 52 (74.2%) patients. The most common symptoms were drooling of saliva in 42 (60%) patients, followed by vomiting in 36 (51.4%) patients. Four (5.7%) patients presented with complications secondary to FB impaction, including hypopharyngeal wall perforation, acquired esophageobronchial fistula, localized esophageal perforation with inflammation, and perforation with stricture formation. The follow-up period ranged from 2 to 12 months, and all patients had complete recovery without any sequelae.

The Scientific World Journal, 2012

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients.

Journal of Evidence Based Medicine and Healthcare, 2015

INTRODUCTION: A foreign body is an endogenous or exogenous substance incongruous with the anatomy of the site where it is found. Foreign body ingestion can affect persons of any age. Despite major advances in diagnostic and therapeutic modalities, foreign body ingestion still causes significant dilemmas in the diagnosis and treatment. Multiple factors play role in the lodgment of these foreign bodies in the food passage. They are diet factor, dental factor, and inebriation and age factors to name a few. Preexisting strictures of esophagus is another local cause of impaction of F.B. The signs and symptoms of foreign body ingestion are quite diverse and often very non-specific. They include complete esophageal obstruction with overflow of secretions and aspiration, to mild odynophagia or dysphagia. Esophageal foreign bodies are most frequently located at the narrowest portion of the esophagus, the level of the crico-Pharynx sphincter. Rarely serious complications of such as mediastini...

Cureus, 2021

Upper esophageal foreign body impaction is a common clinical presentation and often requires medical attention. The most common foreign bodies encountered in the adult population are food-related, e.g., steak pieces and meat bones. Endoscopic interventions are indicated when the foreign objects fail to pass spontaneously. The standard methods to remove these foreign bodies include push technique and retrieval methods using various endoscopic instruments. However, we report a unique method that was used to remove a large upper esophageal impacted foreign body refractory to removal by standard procedures.