Endoscopic techniques and factors for complications in pediatric esophageal foreign body removal.

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.