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Ishihara Y, Ichita C, Jinushi R, Sasaki A. Clinical assessment of computed tomography for detecting ingested blister packs: A single-center retrospective study. DEN OPEN 2025; 5:e406. [PMID: 39011510 PMCID: PMC11248714 DOI: 10.1002/deo2.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
Objectives Blister pack (BP) ingestion poses serious risks, such as gastrointestinal perforation, and accurate localization by computed tomography (CT) is a common practice. However, while it has been reported in vitro that CT visibility varies with the material type of BPs, there have been no reports on this variability in clinical settings. In this study, we investigated the CT detection rates of different BPs in clinical settings. Methods This single-center retrospective study from 2010 to 2022 included patients who underwent endoscopic foreign body removal for BP ingestion. The patients were categorized into two groups for BP components, the polypropylene (PP) and the polyvinyl chloride (PVC)/polyvinylidene chloride (PVDC) groups. The primary outcome was the comparison of CT detection rates between the groups. We also evaluated whether the BPs contained tablets and analyzed their locations. Results This study included 61 patients (15 in the PP group and 46 in the PVC/PVDC group). Detection rates were 97.8% for the PVC/PVDC group compared to 53.3% for the PP group, a significant difference (p < 0.01). No cases of BPs composed solely of PP were detected by CT. Blister packs were most commonly found in the upper thoracic esophagus. Conclusions Even in a clinical setting, the detection rates of PVC and PVDC were higher than that of PP alone. Identifying PP without tablets has proven challenging in clinical. Considering the risk of perforation, these findings suggest that esophagogastroduodenoscopy may be necessary, even if CT detection is negative.
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Affiliation(s)
- Yo Ishihara
- Department of Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan
- Department of Palliative Medicine International University of Health and Welfare Narita Hospital Chiba Japan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan
- Department of Health Data Science Yokohama City University Kanagawa Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan
- Department of Gastroenterology Saitama Medical University International Medical Center Saitama Japan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan
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2
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Heise J, Kreysel C, Blank M, Euler P, Melchior I, Johnen M, Planker M, Ballauff A, Czypull M, Frieling T. [Bolus obstruction within the esophagus - an analysis over 5 years]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1603-1607. [PMID: 36990446 DOI: 10.1055/a-2029-6468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND The removal of bolus impaction within the esophagus is an indication for emergency endoscopy. The current guideline of the European Society of Gastrointestinal Endoscopy (ESGE) recommends gently pushing the bolus into the stomach. This view is discerned by many endoscopists because of the increased risk of complications. In addition, the use of an endoscopic cap for bolus removal is not mentioned. MATERIAL AND METHODS In a retrospective analysis from 2017 to 2021 we investigated 66 adults and 11 children with acute bolus impaction within the esophagus. RESULTS Eosinophilic esophagitis, reflux esophagitic /peptic stenosis and Schatzki Ring caused 57.6%, esophageal and bronchial carcinoma 18%, esophageal motility disorders 4.5%, Zenkers diverticulum 1.5% and radiation esophagitis 1.5% of the bolus obstructions. The reason remained unclear in 16.7% of the cases. The spectrum was comparable in children with additional 2 cases with esophageal atresia and stenosis. The reason was unclear in 2 cases. Removal of bolus impaction was successful in 92.4% in adults and 100% in children. Bolus obstruction in adults was successfully removed solely by endoscopic cap in 57.6% and 75% in children. Pushing the bolus into the stomach without disintegration was possible in only 9% of cases. CONCLUSION Flexible endoscopy is an effective ermergency intervention for removal of bolus obstruction within the esophagus. Uncontrolled pushing the bolus into the stomach without view cannot be recommended. An endoscopic cap is a good extension for safe bolus removal.
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Affiliation(s)
- Jürgen Heise
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Michael Blank
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Philipp Euler
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ilka Melchior
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Michaela Johnen
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Manfred Planker
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Antje Ballauff
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Martina Czypull
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Thomas Frieling
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
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3
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Ino Y, Kitamura M, Nomoto Y, Iwashita C, Miura Y, Yano T, Yamamoto H. A loop cutter is an ideal gripper for endoscopic removal of press-through-package sheets. Endoscopy 2023; 55:E889-E891. [PMID: 37442174 PMCID: PMC10344620 DOI: 10.1055/a-2113-9265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Yuji Ino
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Masafumi Kitamura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshie Nomoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Chihiro Iwashita
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Tomonori Yano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Calini G, Ortolan N, Battistella C, Marino M, Bresadola V, Terrosu G. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol 2023; 35:962-967. [PMID: 37395211 DOI: 10.1097/meg.0000000000002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Harmfulness of foreign body ingestion and food bolus impaction (FBIs) varies according to geographical area, population, habits, and diet. Therefore, studies may not draw generalizable conclusions. Furthermore, data regarding FBIs management in Europe are limited and outdated. This study aimed to analyze the endoscopic management and outcomes of FBIs in an Italian tertiary care hospital to identify risk factors for endoscopic failure. METHODS We retrospectively reviewed patients who underwent upper gastrointestinal endoscopy for FBIs between 2007 and 2017. Baseline, clinical, FBIs, and endoscopic characteristics and outcomes were collected and reported using descriptive statistics and logistic regression analyses. RESULTS Of the 381 endoscopies for FBIs, 288 (75.5%) were emergent endoscopy and 135 (35,4%) included underlying upper gastrointestinal conditions. The study population included 44 pediatric patients (11.5%), 54 prisoners (15.8%), and 283 adults (74.2%). The most common type and location of FBIs were food boluses (52.9%) and upper esophagus (36.5%), respectively. While eight patients (2.1%) developed major adverse events requiring hospital admission, the remainder (97.9%) were discharged after observation. No mortality occurred. Endoscopic success was achieved in 263 of 286 (91.9%) verified FBIs endoscopies. Endoscopic failure (8.04%) was associated with age, bone, disk battery, intentional ingestion, razor blade, prisoners, and stomach in the univariate analysis. Multivariate logistic regression revealed that intentional ingestion was associated with endoscopic failure (odds ratio: 7.31; 95% confidence interval = 2.06-25.99; P = 0.002). CONCLUSION Endoscopy for FBIs is safe and successful, with low hospital admission rate in children, prisoners, and adults. Intentional ingestion is a risk factor of endoscopic failure.
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Affiliation(s)
- Giacomo Calini
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | | | - Claudio Battistella
- Department of Medical and Biological Sciences, Section of Statistics, University of Udine
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - Vittorio Bresadola
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | - Giovanni Terrosu
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
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Demiroren K. Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines. Pediatr Gastroenterol Hepatol Nutr 2023; 26:1-14. [PMID: 36816435 PMCID: PMC9911172 DOI: 10.5223/pghn.2023.26.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 08/30/2022] [Indexed: 01/15/2023] Open
Abstract
Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.
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Affiliation(s)
- Kaan Demiroren
- Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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6
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Study on the Effect of Different Endoscopic Auxiliary Treatment of Gastric Mucosal Microtumor. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2557952. [PMID: 36267085 PMCID: PMC9578834 DOI: 10.1155/2022/2557952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of endoscopy in the treatment of gastric mucosal microtumors. Methods A total of 229 patients with gastric mucosal microtumors were treated in our hospital from January 2016 to December 2021. All patients were divided into three groups group A, group B, and group C. Group A was treated with a transparent cap combined with circle-assisted endoscopic resection, group B with ligator combined with circle-assisted endoscopic resection, and group C with endoscopic mucosal tumor resection. The effects of the three groups were observed. Results There were 47 patients in group A, 17 males, and 30 females, aged 36-69 years, with an average age of 55.6 ± 9.2 years. There were 54 patients in group B, 18 males, and 36 females, aged 38-72 years, with an average age of 57.6 ± 7.7 years. There were 128 patients in group C, 29 males, and 99 females, aged 33-78 years, with an average age of 55.6 ± 8.4 years. There is no significant difference in age and sex between group A, group B, and group C (P > 0.05). The incidence of postoperative complications in group B (66.7%) was significantly higher than that in group A (57.4%) and group C (53.9%) (all P < 0.05). The incidence of postoperative complications in group A (57.4%) was higher than that in group C (53.9%), and the difference was statistically significant (P < 0.05). Conclusion Endoscopic mucosal resection and ligation combined with circle-assisted endoscopic resection are effective and safe in the treatment of gastric mucosal microtumors, but it needs to be combined with targeted nursing measures. The transparent cap combined with ring-assisted endoscopic resection has a significant effect on the treatment of gastric mucosal micromasses, reducing operative complications.
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Mawatari F, Komatsu N, Oshiro R, Arima T, Fukuda S, Kita Y, Fukahori A, Nakao K. Successful removal of an accidentally swallowed press‐through package sheet using a detachable snare: A case report. DEN OPEN 2022; 2:e41. [PMID: 35310747 PMCID: PMC8828184 DOI: 10.1002/deo2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/02/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Abstract
Accidental swallowing of press‐through package (PTP) sheets that could cause esophageal perforation is commonly encountered in emergency departments requiring early detection and removal. We report a case in which an accidentally swallowed PTP sheet was removed from the esophagus using a detachable snare after usual endoscopic methods proved ineffective. A Japanese woman in her 60s visited the emergency department with a persistent sore throat. Cervicothoracic computed tomography revealed presence of a PTP sheet in the cervical esophagus, and emergency endoscopy was performed. Pre‐endoscopy simulations using a sheet identical to the one swallowed by the patient indicated that the sheet would not have been retrievable using an overtube (its inner diameter was smaller than the sheet's diameter) and grasping forceps (they slipped off the sheet). It was successfully removed using a detachable snare, a device normally employed in colorectal polypectomy, allowing us to ligate the end of the sheet and pull it into the overtube. To the best of our knowledge, this is the first report of endoscopic removal of a PTP sheet from the esophagus using a detachable snare. We suggest that this novel method would facilitate removal of esophageal PTP sheets.
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Affiliation(s)
| | - Naohiro Komatsu
- Department of Gastroenterology and Hepatology Graduate School of Biomedical Sciences Nagasaki University Nagasaki Japan
| | - Ryosaku Oshiro
- Department of Internal Medicine Juzenkai Hospital Nagasaki Japan
| | - Tetsuhiko Arima
- Department of Gastroenterology Juzenkai Hospital Nagasaki Japan
| | - Sachiko Fukuda
- Department of Gastroenterology Juzenkai Hospital Nagasaki Japan
| | - Yoshiko Kita
- Department of Gastroenterology Juzenkai Hospital Nagasaki Japan
| | - Aiko Fukahori
- Department of Gastroenterology Juzenkai Hospital Nagasaki Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology Graduate School of Biomedical Sciences Nagasaki University Nagasaki Japan
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8
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Sagvand BT, Najafali D, Yardi I, Sahadzic I, Afridi L, Kohler A, Afridi I, Kaur N, Tran QK. Emergent Endoscopy for Esophageal Foreign Body Removal: The Impact of Location. Cureus 2022; 14:e21929. [PMID: 35273870 PMCID: PMC8900722 DOI: 10.7759/cureus.21929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background Timely intervention is essential for the successful removal of ingested foreign bodies. Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. However, because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes. Methodology We reviewed charts of patients who underwent EGD for foreign body removal at an academic quaternary center between January 01, 2012, and December 31, 2020. We defined successful EGD as retrieval of the foreign body at the first attempt and not requiring subsequent endoscopy or surgical intervention. We performed descriptive and inferential statistical analyses and conducted classification and regression trees to compare endoscopy procedure length (EPL) and hospital length of stay (HLOS) between different locations. Results We analyzed 77 patients, of whom 13 (17%) underwent endoscopy in the ICU, 46 (60%) in the OR, and 18 (23%) in the ED. Endoscopic removal failed in four (5%) patients. Endoscopy length was significantly shorter in the OR (67 (48-122) minutes) versus the ICU (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009). Time to procedure was similar if the procedure was performed in the ED (278 minutes), the ICU (331 minutes), or the OR (378 minutes). The median (interquartile range) of HLOS for the OR group (0.87 (0.54-2.03) days) was significantly shorter than the ICU group (2.26 (1.47-6.91) days, P = 0.007). Conclusions While performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter EPL and HLOS, no location was inferior for overall outcomes. Further prospective and randomized studies are needed to confirm our findings.
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Suga T, Oguchi T, Maruyama K. Successful endoscopic mucosal incision and enucleation of an implanted press-through package sheet in the esophageal wall. Dig Endosc 2022; 34:e24-e25. [PMID: 34816487 DOI: 10.1111/den.14184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Tomoaki Suga
- Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Takaya Oguchi
- Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Kiyotomi Maruyama
- Department of, Surgery, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
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10
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Yamamoto K, Okamoto T, Fukuda K. Endoscopic removal of a spoon from the stomach using a 2-channel endoscope. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:347-349. [PMID: 34401628 PMCID: PMC8351347 DOI: 10.1016/j.vgie.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Endoscopic removal of a spoon from the stomach using a 2-channel scope, with simultaneous use of alligator forceps and an endoscopic snare.
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Affiliation(s)
- Kazuki Yamamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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11
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Wang X, Zhao J, Jiao Y, Wang X, Jiang D. Upper gastrointestinal foreign bodies in adults: A systematic review. Am J Emerg Med 2021; 50:136-141. [PMID: 34365062 DOI: 10.1016/j.ajem.2021.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/04/2021] [Accepted: 07/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes. METHODS We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms "foreign body AND upper gastrointestinal NOT child". Finally, we got 7 articles between 2001 and 2020 and extracted the information. RESULTS A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391).
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Affiliation(s)
- Xinyue Wang
- Department of Burns and Plastic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Jie Zhao
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Ya Jiao
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Xinglei Wang
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China
| | - Duyin Jiang
- Department of Emergency Medical Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China; Department of Burns and Plastic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, PR China.
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12
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Takasu A, Ikeya T, Fukuda K. Endoscopic Removal of a Press-Through Pack from the Anal Canal. Case Rep Gastroenterol 2021; 15:137-141. [PMID: 33708061 PMCID: PMC7923698 DOI: 10.1159/000511751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
The incidence of press-through pack (PTP) ingestion has been increasing. In many cases, the ingested PTP is lodged in the esophagus. Here, we report a case of endoscopic removal of a PTP from the anal canal. An 89-year-old man with mild dementia presented with a 3-day history of anal pain. On digital rectal examination, we felt a hard and sharp object, which could not be manually removed due to its shape. Therefore, it was removed endoscopically. We inserted an endoscope with a large-caliber soft oblique cap and observed the PTP in the anal canal. It was successfully removed using grasping forceps. The patient was stable, with only mild anal fissures, and no serious complications such as perforation and bleeding were observed. It is generally recognized that a PTP that reaches the large intestine is naturally expelled. Even if a PTP could pass through the pylorus or the small intestine, it could still be difficult to discharge naturally from the anus without discomfort or pain, as in this case.
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Affiliation(s)
- Ayaka Takasu
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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13
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Wang H, Lin DL, Wang XF, Qu YW, Wu LS, Yu P, Wang WA. Endoscopic management of foreign bodies in the gastrointestinal tract: A retrospective study of 109 cases. Shijie Huaren Xiaohua Zazhi 2020; 28:1243-1248. [DOI: 10.11569/wcjd.v28.i24.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ingestion of foreign bodies in the gastrointestinal tract is commonly encountered in clinical practice. Reports on individualized endoscopic removal of gastrointestinal foreign bodies are scarce.
AIM To explore the method of individualized endoscopic removal of indigested foreign bodies in the gastrointestinal tract to improve the success rate of foreign body endoscopic removal.
METHODS The clinical data of patients with digestive tract foreign bodies treated at the Third Medical Center of PLA General Hospital (former General Hospital of Armed Police Forces) from July 2014 to April 2019 were retrospectively analyzed.
RESULTS One hundred and nine patients were included in the study, including 46 men (42.2%) and 63 women (57.8%). Their age ranged from 11 to 88 years, with an average age of 57.3 years; 52 cases (47.7%) were elderly. The most common type of foreign body was jujube kernel (53 cases, 48.6%), followed by fish bone (24 cases, 22%) and food mass (15 cases, 13.8%). The most common location of foreign bodies in the digestive tract was the esophagus (84 cases, 76.9%), followed by the colon (7 cases, 6.4%), anastomosis (6 cases, 5.5%), stomach (5 cases, 4.5%), and duodenum (2 cases, 1.8%). Pharynx foreign bodies can be directly removed with foreign body forceps, with the shortest time taken (average, 2.5 ± 0.7 min). For esophageal foreign bodies, foreign body forceps were used to clamp one end of the foreign bodys, exert to the opposite side, make it leave the mucous membrane and parallel to the lumen, and then remove. The foreign body in the upper part of the esophagus can be added with a casing or transparent cap. The foreign body in the lower esophagus can be pushed into the stomach and then removed under the endoscope. The average time taken for removal of foreign bodies in the upper, middle, and lower esophagus was 7.0 ± 5.3, 8.3 ± 6.3, and 3.3 ± 1.2, respectively. Anastomosis foreign bodies were often removed using a trap, and the average time taken was 6.2 ± 4.1 min. When removing the foreign body in the stomach, appropriate instrument should be selected according to the shape of the foreign body. In order to avoid scratching the mucosa by the tip of the foreign body, a transparent cap or a self-made protective device can be used. The average time used was 8.4 ± 1.7 min. Duodenal foreign body was usually dragged into the stomach tbefore removal, and the average time taken was 9.2 ± 3.1 min. Colonic foreign bodies mainly occurred in the sigmoid colon and were very difficult to remove. A clamp was usually used to clamp one end of the foreign body, exert to the opposite side, cause it to be parallel to the intestinal lumen, and then remove. The longest time was taken for colonic foreign bodies, with an average time of 15.6 ± 8.0 min. The success rate of endoscopic removal of foreign bodies in the digestive tract was 97.2% (106/109).
CONCLUSION Individualized endoscopic removal of gastrointestinal foreign bodies is a safe and effective method.
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Affiliation(s)
- Huan Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Dong-Lei Lin
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Xiao-Feng Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Ya-Wei Qu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Li-Sha Wu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Peng Yu
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei-An Wang
- Department of Gastroenterology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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