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Published on: January 17, 2011
Endoscopic techniques and factors for complications in pediatric esophageal foreign body removal
Lucas Dourado Mapurunga Pereira1, Márcio Alencar Barreira2, Thiago Nepomuceno de Saboia Mont'Alverne1
1Department of Digestive Endoscopy, General Hospital of Fortaleza, Fortaleza 60150-160, Ceará, Brazil.
Insights
Foreign body ingestion in children is common, with coins most frequently lodged in the upper esophagus. Flexible endoscopy is more effective and safer for removing esophageal foreign bodies than rigid endoscopy.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Public Health
Background:
- Foreign body (FB) ingestion presents significant challenges in pediatric endoscopy.
- Esophageal FB impaction emergencies are most common in children, necessitating study of epidemiological profiles and treatment strategies.
Purpose of the Study:
- To characterize children with esophageal FB impaction presenting to emergency care.
- To identify factors associated with FB impaction complications.
- To compare the effectiveness of rigid (RE) and flexible endoscopy (FE).
Main Methods:
- Retrospective cohort study of 166 children undergoing esophageal FB removal via endoscopy (84 FE, 82 RE).
- Primary outcomes: endoscopic technique efficacy and complication factors.
- Secondary outcomes: age, gender, symptoms, hospital stay, and FB location.
Main Results:
- Preschool boys most commonly ingested coins (57.2%), with impaction in the cervical esophagus (60.8%) and delays >24 hours (62.7%).
- Endoscopic removal was successful in 90.4% of cases.
- Flexible endoscopy showed higher efficacy (95.2%) compared to rigid endoscopy (85.4%), with fewer perforations (4.8% vs 11%).
Conclusions:
- Coins are the most frequent esophageal FBs in preschool boys, typically in the upper esophagus.
- Battery ingestion, delayed removal (>48 hours), and thoracic impaction increase complication risk.
- Flexible endoscopy is generally more effective for esophageal FB removal, with both procedures demonstrating safety.
Background:
Foreign body (FB) ingestion is one of the most challenging clinical situations faced by endoscopists. Most esophageal FB impaction emergencies occur in children. It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children, as it can help in the development of more effective, safe and personalized preventive and therapeutic strategies.
Aim:
To define the profile of children seeking emergency care due to FB impaction in the esophagus, analyze factors associated with complications, and evaluate the effectiveness of rigid (RE) and flexible endoscopes (FE).
Methods:
A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy (FE = 84 vs RE = 82) at the Dr. José Frota Institute was performed. The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications. The secondary outcomes were age group, gender, symptoms, length of hospital stay, and location of the FB.
Results:
Boys (66.9%), preschoolers (43.4%), FB > 24 hours (62.7%), cervical esophagus (60.8%), coin ingestion (57.2%) and complaints of dysphagia (24.9%) and sialorrhea (23.1%) were the predominant findings. Endoscopy was successful (90.4%) with sedation (89.1%). A total of 97% of patients were discharged from the hospital, while 3% died. The average hospital stay length was 2.6 days. Most patients did not experience complications predominated (64.5%). Esophageal perforations were more frequent after RE (11% vs 4.8%), while FE was more effective (95.2% vs 85.4%). The χ 2 test or Fisher's exact test was used to compare categorical variables. For continuous variables, the Kruskal-Wallis test or analysis of variance was used. Statistical analyses were performed in R® software (version 1.3.1093).
Conclusion:
Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys. Risk factors for complications due to esophageal FB include battery ingestion, delayed removal (> 48 hours) and lodging in the thoracic esophagus. FE was generally more effective than RE for removing FBs; both procedures are safe.
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