Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8125-8131
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8125
Risk factors for complications associated with upper gastrointestinal foreign bodies
Kyong Hee Hong, Yoon Jae Kim, Jae Hak Kim, Song Wook Chun, Hee Man Kim, Jae Hee Cho
Kyong Hee Hong, Jae Hak Kim, Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School, Goyang 410-773, South Korea
Yoon Jae Kim, Jae Hee Cho, Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, South Korea
Song Wook Chun, Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang 412-270, South Korea
Hee Man Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 220-701, South Korea
Author contributions: Hong KH and Kim YJ equally contributed to this work, they performed the majority of the work including collecting, analyzing, and interpreting the data and writing the report; Chun SW was also participated in analyzing and interpreting the data; Kim JH, Kim HM and Cho JH designed and coordinated the study.
Supported by Gachon University Gil Medical Center, No. 2013-49 and No. 2013-35, to Cho JH and Kim YJ.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Myongji Hospital and Dongguk University Ilsan Hospital.
Informed consent statement: This retrosepcitve study was peformed under IRB approval, all data is de-identified for statistical analysis. Therefore, we think that a waiver of informed consent may be justifiable under this situation.
Conflict-of-interest statement: All authors have no conflicts of interest to declare or financial ties to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jae Hee Cho, MD, Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, South Korea. jhcho9328@gmail.com
Telephone: +82-32-4602187 Fax: +82-32-4603408
Received: December 10, 2014
Peer-review started: December 11, 2014
First decision: February 10, 2015
Revised: February 23, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: July 14, 2015
Processing time: 215 Days and 21.9 Hours
Abstract

AIM: To investigate predictive risk factors associated with complications in the endoscopic removal of foreign bodies from the upper gastrointestinal tract.

METHODS: We retrospectively reviewed the medical records of 194 patients with a diagnosis of foreign body impaction in the upper gastrointestinal tract, confirmed by endoscopy, at two university hospital in South Korea. Patient demographic data, including age, gender, intention to ingestion, symptoms at admission, and comorbidities, were collected. Clinical features of the foreign bodies, such as type, size, sharpness of edges, number, and location, were analyzed. Endoscopic data those were analyzed included duration of foreign body impaction, duration of endoscopic performance, endoscopic device, days of hospitalization, complication rate, 30-d mortality rate, and the number of operations related to foreign body removal.

RESULTS: The types of upper gastrointestinal foreign bodies included fish bones, drugs, shells, meat, metal, and animal bones. The locations of impacted foreign bodies were the upper esophagus (57.2%), mid esophagus (28.4%), stomach (10.8%), and lower esophagus (3.6%). The median size of the foreign bodies was 26.2 ± 16.7 mm. Among 194 patients, endoscopic removal was achieved in 189, and complications developed in 51 patients (26.9%). Significant complications associated with foreign body impaction and removal included deep lacerations with minor bleeding (n = 31, 16%), ulcer (n = 11, 5.7%), perforation (n = 3, 1.5%), and abscess (n = 1, 0.5%). Four patients underwent operations because of incomplete endoscopic foreign body extraction. In multivariate analyses, risk factors for endoscopic complications and failure were sharpness (HR = 2.48, 95%CI: 1.07-5.72; P = 0.034) and a greater than 12-h duration of impaction (HR = 2.42, 95%CI: 1.12-5.25, P = 0.025).

CONCLUSION: In cases of longer than 12 h since foreign body ingestion or sharp-pointed objects, rapid endoscopic intervention should be provided in patients with ingested foreign bodies.

Keywords: Emergency department; Foreign body; Upper gastrointestinal tract; Endoscopy; Complication

Core tip: We investigated the status of foreign bodies in the upper gastrointestinal tract and assessed risk factors for complications associated with the endoscopic removal of ingested foreign objects. We concluded that a longer duration of impaction, above 12 h, and sharp-pointed objects were related to the occurrence of endoscopic complications and failure. A strength of this study is that we evaluated risk factors for complications according to particular impaction time, in contrast to published studies that reported simply “long” impaction duration as a risk factor or that impaction time was not associated with the risk of complications.