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Education in practice
Foreign body ingestion: dos and don’ts
  1. Aymeric Becq1,2,
  2. Marine Camus1,2,
  3. Xavier Dray1,2
  1. 1Endoscopy Department, Hôpital Saint Antoine, APHP, Sorbonne Université, Paris, Île-de-France, France
  2. 2Paris On-call Endoscopy Team, Assistance Publique Hopitaux de Paris, Paris, Île-de-France, France
  1. Correspondence to Professor Xavier Dray, Endoscopy Unit, Hôpital Saint Antoine, APHP, Sorbonne Université, 75012 Paris, Île-de-France, France; xavier.dray{at}aphp.fr

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Introduction

Foreign body ingestion comprises a true foreign body (ie, non-food) ingestion and food bolus impaction. Foreign body ingestion is not uncommon and accounts for roughly 4% of urgent endoscopies undertaken.1 2 True foreign body ingestion is mostly encountered in paediatric populations with 75% of cases occurring in less than 5-year-old children.1 Coins, buttons, plastic items, batteries and bones are common culprits.3 Food bolus impaction on the other hand is mostly seen in adults, usually accidental (95% of cases). Steakhouse syndrome, animal bones, toothpicks and fish bones are the most frequent.2 True foreign body ingestion (coins and dentures) is rare in adults. Intentional true foreign body ingestion can be seen in patients with psychiatric illness, prisoners (secondary gain) and drug dealers (‘body packing’). Underlying oesophageal conditions including eosinophilic oesophagitis (10% in adults, up to 50% in children), motility disorder, stenosis and diverticula are frequent.2 4 Most ingested foreign bodies will pass spontaneously.5 However, 10%–20% require endoscopic removal, and less than 1% require surgical extraction or treatment of a complication.6 This review focuses on the management of foreign bodies located in the upper gastrointestinal tract, in adults. The quality of evidence of the guidelines is low; however, substantial clinical experience provides strong levels of recommendation.7 8 The management of rectal foreign bodies mostly relies on surgical, transanal extraction and is not detailed herein.

Initial evaluation

Precise history (type of foreign body, time of onset) is essential. Physical examination is also mandatory. Most patients are asymptomatic. Symptoms arise when the foreign body is stuck in the oesophagus or when a complication occurs (obstruction and perforation).9 Emesis, retching, blood-stained saliva, hypersialorrhoea, wheezing and/or respiratory distress in non-communicative patients (children and psychiatric patients) are suggestive of foreign body impaction.7 Oesophageal impaction (food bolus) is often symptomatic: retching, …

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Footnotes

  • Contributors XD has selected the relevant references for review, the various cases for illustrations, and has written the outline of the article. AB and MC have written the complete version of the article. All authors have revised the final version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MC is a consultant for Boston Scientific and Cook Medical. XD is cofounder and shareholder of Augmented Endoscopy and has acted as a consultant for Alfasigma, Bouchara Recordati, Boston Scientific, Fujifilm, Medtronic, and Pentax.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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