Ingested foreign bodies include both true foreign bodies (FTBs) and food impactions. According to the European Society of Gastrointestinal Endoscopy (ESGE), they are classified according to their physical characteristics as food impaction, foamy objects, whether sharp, pointed or long [1]. It is a frequent reason for emergency room visits and can be life-threatening in the event of complications. It is considered to be the second most common reason for emergency oesogastroduodenal endoscopy. In 70% of the cases, it involves accidental ingestion by children. In adults, however, accidental food impaction is the most frequently described. It is usually found in the elderly, and most commonly, with toothless patients, or those with underlying esophageal pathology. Less frequently, ingestion is voluntary in adult prisoners or those with psychiatric disorders [2-3].
In most cases, the outcome after ingestion of a strange body is favorable, with spontaneous elimination of the EC without incident in 80% of cases. However, endoscopic extraction is necessary in 20% of the cases, and emergency surgery occurs in the event of a complication in 1% of the cases [4].
Diagnosis is generally straightforward in adults when the circumstances of ingestion are reported. In children, however, the accident is often unrecognized, leading to a delay in diagnosis.
Initial treatment in the emergency department should include details of the presenting symptoms, the physical characteristics of the ingested object or food (on which treatment depends), the time of the accident, any signs of complications (fever, subcutaneous emphysema, peritoneal syndrome, digestive hemorrhage) and the presence or absence of underlying digestive pathology. Complementary radiological examinations, notably a chest X-ray and/or an unprepared abdomen, are only indicated in the case of a radio-opaque body, food impaction with a bony component, or an object of unknown characteristics. A CT scan is performed in complicated cases.
After this urgent radio-clinical assessment, and in the absence of any contraindication to endoscopy (presence of a complication or body packing), urgent endoscopic extraction is discussed, depending on the foreign body's characteristics and the digestive level impaction. Generally speaking, esophageal localizations represent genuine emergencies compared to other segments.
Thus, according to the European recommendations, endoscopic extraction is indicated [1]:
Within 2 hours of the accident (6 hours at the latest) for esophageal impactions of stenosing, sharp or pointed bodies, and batteries.
Within 24 hours gastric localization of long, sharp, or pointed objects, magnets, batteries, and strange, non-stenotic esophageal bodies.
Within 72 hours for medium-sized gastric objects and foams.
Endoscopic management requires an experienced endoscopist and appropriate technical facilities. The examination is usually performed under general anaesthetic, after airway protection. The endoscopy room must be equipped with a wide range of extraction equipment adapted to each foreign body. The use of a protective cap is essential for potentially traumatic (sharp) objects. In line with these recommendations, endoscopy enables extraction in 90% of cases, with a 5% risk of complications [5].
It is worth noting that endoscopic extraction is contraindicated in the case of "body packing", given the risk of overdose following bag tearing and intraluminal leakage of the product. In such cases, radiological monitoring of the progress of the bags should be proposed. Emergency surgery is indicated in the event of rupture or complications such as occlusion.
Ingested foreign bodies are an emergency requiring endoscopic management. Endoscopic extraction of these bodies is an effective method, with a low risk of complications if the recommendations are accurately followed.
References:
[1] Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C and al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016 May;48(5):489-96.
[2] Britschu O, Caron B, Berdugo Y, Gronier O. Prise en charge des corps étrangers du tractus digestif : Hépato-Gastro & Oncologie Digestive 2021 ;28 : 38-45.
[3] Ferrari D, Aiolfi A, Bonitta G, Riva CG, Rausa E, Siboni S, Toti F, Bonavina L. Flexible versus rigid endoscopy in the management of esophageal foreign body impaction: systematic review and meta-analysis. World J Emerg Surg. 2018 Sep 12;13:42.
[4] Lachaux A, Letard JC, Laugier R, Gay G, P. Arpurt J, Boustière C and al. Les corps étrangers ingérés : Recommandations de la SFED. Acta endoscopica 2007; 37(1): 91-3.
[5] Yuan J, Ma M, Guo Y, He B, Cai Z, Ye B and al. Delayed endoscopic removal of sharp foreign body in the esophagus increased clinical complications: An experience from multiple centers in China. Medicine (Baltimore). 2019 Jun;98(26):e16146.
