![]() Standard flexible gastroscopes may be used in most cases. General anaesthesia with endotracheal intubation is required to ensure airway protection. ![]() Of note, conservative management is preferred to endoscopic extraction of illicit drug packages. A sharp foreign body beyond the duodenum should be extracted by surgery if it fails to progress after 3 days. Blunt foreign bodies should be removed from the duodenum after 4–8 days, and from the stomach within 3-4 weeks. All foreign bodies impacted in the oesophagus should be extracted within 24 hours. An urgent procedure is required if the foreign body is lodged in the upper third of the oesophagus (Figure 1), is causing complete oesophageal obstruction, or if the patient has ingested magnets, a button battery, or a sharp object. Indeed, endoscopic extraction is the cornerstone of the management of foreign-body ingestion. Overall, clinical evaluation, imaging, and medication trial should not delay endoscopic extraction. CT scan is the preferred imaging modality, in the rare situation where any is necessary, although it is rarely needed (2)ĭata are conflicting about the use of effervescent agents (so-called fizzy drinks) and pharmaceutical treatments (e.g. Plain or bi-plane radiography is recommended for evaluation of radiopaque foreign bodies, but contrast studies should be avoided because they can delay treatment, impair visualisation during subsequent endoscopy, and worsen complications. Radiographic evaluation is not always necessary, and it is not useful in non-complicated, non-bony food impaction. Symptoms generally arise when the foreign body becomes stuck in the oesophagus or when a complication occurs (obstruction, perforation, etc). Precise history (type of foreign body and time of onset) and physical examination are mandatory. Initial evaluation is essential in all presenting cases but should not delay urgent treatment. Most ingested foreign bodies pass spontaneously, but 10–20% of cases require endoscopic removal and up to 1% could require surgical extraction or treatment of a complication. Impaction caused by a foreign body or food bolus is associated in 30% of cases with underlying oesophageal conditions, including eosinophilic oesophagitis, motility disorder, stenosis, and diverticula. Intentional true foreign body ingestion is most frequently seen in patients with psychiatric illness, prisoners, and drug dealers (‘body-packing’). Accidental food bolus impaction is mostly seen in adults, most frequently involving a food mass (“steakhouse syndrome”), animal bones, fish bones, and rarely dentures or toothpicks are among the most common foreign bodies ingested by adults. ![]() Coins, buttons, plastic items, batteries, and bones are commonly swallowed by children. ![]() non-food) ingestion and food bolus impaction account for 4% of urgent endoscopies. Clinical trials are rare, but substantial clinical experience provides strong levels of recommendation.įoreign-body ingestion and food bolus impaction Defer endoscopic extraction because of radiographic evaluation.įoreign-body ingestion and food bolus impaction are frequent, and associated with a wide array of clinical presentations.Attempt endoscopic extraction of a rectal foreign body.Defer endoscopic extraction of a sharp or pointed foreign body.Defer endoscopic extraction of food bolus impaction later than 12 to 24 hours.Attempt an endoscopic extraction of drug-containing packets.Anticipate the need for intubation for airway protection before urgent endoscopic retrieval. ![]()
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