Endoscopic removal of 115 foreign bodies from the upper gastrointestinal tract in children

Over the past 25 years (1984–1992 in the Apáthy István and 1992–2002 in Heim Pál Children Hospital, thereafter until 2009 in Pediatric Surgical and Traumatological Department of St. John's Hospital) 115 foreign bodies were removed endoscopically from the esophagus, stomach and duodenum of 115 children. The age of patients was 6 months to 6 years. At older ages only pschycosomatically retarded children swallowed foreign objects intentionally.

The most problematic areas were hypopharynx, cardia, pylorus, duodenal loop, the region of ligament of Treitz. By any suspicion of swallowed foreign body X ray investigations should be performed on standing and lying positions as well to identify the position and movement and the of the foreign body. In 10 cases we had to use contrast screening to identify the exact position of the foreign body.

We found foreign bodies of three types:

• Round, oval, sphere-shaped ones without sharp edges. These objects (coins, marbles, buttons, and safety closed pins) cause the fewest problems. In such cases the patient should not be hospitalized. Stool should be examined. Admission to the hospital should only be suggested in case of abdominal pain, vomiting or bleeding. In asymptomatic cases (coins in the stomach) we can wait up to 4–5 weeks.

• In case of sharp edges, by blocking tendency, repeated X ray pictures should be taken to localize the position of the foreign body. Most commonly we found needles, drawing pins less then 2cm, little keys, rings, ear rings, little puzzle, clips. If vomiting, abdominal pain or bleeding appears urgent endoscopy must be performed.

• We found a number of narrow, long items, as pencils, long nails, long keys and toys with irregular form or sharp.

If the button remains for longer time in the stomach, it should cause ulceration and perforation of the stomach wall. Dangerous complication of remained foreign body in the esophagus is perforation or mediastinitis

All endoscopic examination were performed under general anesthesia using fiberoptic endoscope (Olympus XP, XP-20, FUJI PE7, XP 160) videoendoscope and foreign body forceps (FG 4L, loop.). Surgery was necessary in two children. In one of them little toy car piece remained in the hypopharynx, in the other case PEG button were broken in the gastric wall. In one case the abdominal CT performed because of abdominal pain revealed blocked button piece in Meckel diverticulum. This button was removed by surgery.

Conclusion:. The endoscopic removal of foreign bodies from upper GI tract of children needs a special skill and it saves the child from surgery. In order to be able to perform a relaxed and calm medical check up we suggest applying balanced general anesthesia. So far we haven't got any complications during or following the endoscopic procedure. In majority of cases the patients were discharged from the hospital one day after the admission.