Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic techniques and factors for complications in pediatric esophageal foreign body removal
Lucas Dourado Mapurunga Pereira, Márcio Alencar Barreira, Thiago Nepomuceno de Saboia Mont’Alverne, Marina Marques Maia, Marcela Alina Jereissati de Castro, Joao Wallace Carvalho de Oliveira, Mariana Marques Maia, Paulo Roberto Cavalcante de Vasconcelos, Alessandrino Terceiro de Oliveira
Lucas Dourado Mapurunga Pereira, Thiago Nepomuceno de Saboia Mont’Alverne, Alessandrino Terceiro de Oliveira, Department of Digestive Endoscopy, General Hospital of Fortaleza, Fortaleza 60150-160, Ceará, Brazil
Márcio Alencar Barreira, Department of Surgery, Dr. José Frota Institute, Fortaleza 60025-061, Ceará, Brazil
Marina Marques Maia, Marcela Alina Jereissati de Castro, Joao Wallace Carvalho de Oliveira, School of Medicine, Christus University Center, Fortaleza 60190-180, Ceará, Brazil
Mariana Marques Maia, Community Health Center, School of Public Health of Ceará, Fortaleza 60165-090, Ceará, Brazil
Paulo Roberto Cavalcante de Vasconcelos, Department of Surgery, Federal University of Ceara, Fortaleza 60020-181, Ceará, Brazil
Co-first authors: Lucas Dourado Mapurunga Pereira and Márcio Alencar Barreira.
Author contributions: Pereira LDM and de Oliveira AT designed the study, performed statistical analysis, developed methodology and contributed to project administration; de Oliveira AT, Maia MM, de Castro MAJ, de Oliveira JWC and Maia MM participated in data collection, interpretation, and analysis; Pereira LDM, de Oliveira AT, Barreira MA, de Saboia Mont’Alverne TN and de Vasconcelos PRC wrote the original draft, performed editing, critical revision, and final approval. All authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Research Ethics Board (number 6.886.384) and Brazil platform system (Approval with CAAE number 79007324.1.0000.5047).
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Data sharing statement: No additional data is available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Alessandrino Terceiro de Oliveira, MD, PhD, Assistant Professor, Department of Digestive Endoscopy, General Hospital of Fortaleza, R. Ávila Goularte, 900 - Papicu, Fortaleza 60150-160, Ceará, Brazil.
ale.terceiro@hgf.ce.gov.br
Received: February 26, 2025
Revised: April 18, 2025
Accepted: May 24, 2025
Published online: July 16, 2025
Processing time: 136 Days and 11.6 Hours
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 χ2 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.
Core Tip: The study described 166 cases of children with esophageal foreign body (FB) impaction, analyzed factors associated with complications, and evaluated the efficacy of rigid (RE) and flexible endoscopy (FE). Coins were the most common FB, and they were primarily lodged in the upper esophagus of preschool-aged children. Risk factors for complications include battery ingestion, delayed removal (> 48 hours), and lodging in the thoracic esophagus. Overall, FE was more effective than RE for FB removal, and both procedures are safe.
