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Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy
Robert Russell1, Alan Lucas, Joffre Johnson
1Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Ave. S., Lowder Building Suite 300, Birmingham, AL, 35233, USA, robert.russell@childrensal.org.
Insights
Pediatric foreign body ingestion requires endoscopic removal. Both rigid (RE) and flexible (FE) endoscopy are effective for esophageal foreign bodies (FBs), with successful removal in 97% of cases.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Surgery
Background:
- Foreign body (FB) ingestion is a frequent pediatric emergency.
- Management of esophageal FBs lacks a consensus on the optimal endoscopic technique.
Purpose of the Study:
- To compare the efficacy and outcomes of rigid endoscopy (RE) and flexible endoscopy (FE) for esophageal FB removal in children.
- To review institutional experience with both RE and FE for pediatric esophageal FB management.
Main Methods:
- Retrospective review of pediatric patients treated for esophageal FBs between 1999 and 2012.
- Comparison of clinical data, management techniques, and complications between RE and FE groups.
- Statistical analysis to identify significant differences between the two endoscopic approaches.
Main Results:
- 657 children underwent treatment for esophageal FB ingestion; 56% were managed with FE.
- Coins were the most common ingested FB (84%), typically lodged in the upper esophagus (78%).
- Successful removal with the initial technique was achieved in 97% of patients, with no significant differences between RE and FE groups, apart from a younger age in the FE group.
Conclusions:
- Both rigid and flexible endoscopy are highly effective for esophageal foreign body removal in children.
- Treatment failures were successfully managed by converting to the alternative endoscopic technique.
- Training in both RE and FE is recommended for pediatric surgeons to ensure comprehensive management capabilities.
Purpose:
Foreign body (FB) ingestion is a common and potentially serious problem in children. Both rigid (RE) and flexible (FE) endoscopic techniques are used for removal of esophageal FBs; however, there is no consensus amongst pediatric surgeons regarding the best method. This study reviewed our experience managing esophageal FBs using both techniques.
Methods:
A 12-year retrospective review of children admitted with an esophageal FB between 1999 and 2012 was undertaken. Clinical data, management techniques, and complications were abstracted. Differences between these two groups were compared with standard statistical methods.
Results:
657 children were treated for esophageal FB ingestion, of which 366 (56%) were treated with FE. The most frequently ingested item was a coin (84%), and FBs were most commonly lodged in the upper third of the esophagus (78%). There was a slightly younger population in the FE group (4.0 vs. 3.3 years, p < 0.01), but otherwise no significant differences were found between the groups. The FB was successfully removed with the initially chosen technique in 97% of patients.
Conclusions:
Esophageal FBs may be successfully removed with either RE or FE. Since treatment failures were managed with conversion to the other technique, both procedures should be included in the training curriculum.
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