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Endoscopic removal of foreign bodies from gastrointestinal tract
B R Thapa1, K Singh, J B Dilawari
1Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh.
Insights
Conservative management of foreign body ingestion in children is effective. Fiberoptic endoscopy successfully removed gastrointestinal foreign bodies, avoiding surgery and complications.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
Background:
- Foreign body ingestion is common in children, particularly those under 5 years old.
- Household objects are the most frequent foreign bodies ingested.
- Clinical presentation varies, including respiratory distress, dysphagia, and hematemesis.
Purpose of the Study:
- To evaluate the efficacy and safety of conservative management and endoscopic retrieval of foreign bodies in children.
- To assess the outcomes of foreign body ingestion in a pediatric population.
Main Methods:
- Retrospective analysis of 42 children with foreign body ingestion.
- Management included conservative observation and fiberoptic endoscopic retrieval.
- Procedures performed under intravenous sedation (diazepam or ketamine).
Main Results:
- Most foreign bodies were household objects located in the stomach and esophagus.
- Endoscopic retrieval was successful for all foreign bodies above the duodenojejunal junction and one in the rectum.
- 19% of foreign bodies passed spontaneously within 4-5 days.
- 21% of patients showed gastric or esophageal erosions on endoscopy.
- No complications from endoscopic procedures or sedation were reported; no surgeries were required.
Conclusions:
- Flexible fiberoptic endoscopy is a minimally invasive and effective treatment for pediatric foreign body ingestion.
- Conservative management and endoscopic removal can prevent surgical intervention and associated complications.
- Successful outcomes depend on a skilled pediatric endoscopist and effective teamwork.
Abstract:
Forty-two children with ingestion of foreign bodies (FB) were managed conservatively. Thirty one (74%) of them were under 5 years of age. At presentation history revealed accidental ingestion in 95% and of being put in the oral cavity by elder sibs in 5% patients. Fifty seven per cent had respiratory distress, 38% had dysphagia and 12% had hematemesis. Foreign bodies were located in the gastrointestinal tract in the stomach (40%), esophagus (26%), small intestine (19%), duodenum (12%) and rectum (2%). A large majority of the FB were constituted by household objects. All the FB above the duodenojejunal junction and one in the rectum were retrieved successfully with fiberoptic endoscopes. In 19% patients, the FB had crossed duodenojejunal junction, and had come out in the stools during 4-5 days observation and these were mostly round in shape. Endoscopic procedures were carried out under intravenous diazepam or ketamine sedation. On endoscopic examination, 21% of them showed erosions in stomach and/or esophagus. No complications of endoscopic procedure or sedation were observed and none of the patients required surgical removal. Removal of FB with flexible fiberoptic endoscopes is less invasive and the best therapeutic option to avoid preventable complications of FB ingestion. In this procedure there is need of a trained and skilled Pediatric endoscopist with lot of patience and a good team work.