Profile of foreign body ingestion and outcomes of endoscopic management in pediatric population

Abstract

Background: Foreign body (FB) ingestion is a frequent gastrointestinal emergency in pediatric population. Improvement in endoscopic techniques and equipment enables nonsurgical management in most situations. Recent data from India on pediatric FB ingestion have been lacking. Aim: The aim of this study was to assess the profile and outcome after endoscopic management of patients <18 years of age presenting with FB ingestion. Patients and Methods: Records of all the children with FB ingestion who had undergone endoscopic removal at our institution during 5 years (2011–2016) were assessed retrospectively. The nature of FB ingested, and success and complication of endoscopic therapy were analyzed. Results: There were 150 pediatric endoscopies during the study period. Of this, 120 (80%) were for removal of ingested FB. Most common (MC) FB was coin (69%). The retrieved FBs were 83 coins, 13 batteries, 5 pins, 4 clips, 2 each of anklets, keys, marbles, and seeds, one each of spoon, blade, spanner, peanut, toe ring, and a pencil. One had trichobezoar. Esophagus was the MC site of location of FB (85/120). FB removal was successful by flexible endoscopy in 97.1%. Four (0.03%) cases were referred for rigid endoscopic/surgical removal by otolaryngologists/ pediatric surgeon. Except for one child developed bronchopneumonia, there was no morbidity or mortality in the study. Conclusion: Endoscopic removal of FB is a safe procedure with excellent outcomes in a specialized gastroenterology unit.

Key words

Endoscopic removal - foreign bodies - pediatric endoscopy

• References

• 1 Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC. et al 2000 annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med 2001; 19: 337-95
• 2 Arana A, Hauser B, Hachimi-Idrissi S, Vandenplas Y. Management of ingested foreign bodies in childhood and review of the literature. Eur J Pediatr 2001; 160: 468-72
• 3 Chen MK, Beierle EA. Gastrointestinal foreign bodies. Pediatr Ann 2001; 30: 736-42
• 4 Kirkham EN, Kane M, Paul SP. Foreign body ingestion in children. Community Pract 2015; 88: 45-8
• 5 Lee JH, Nam SH, Lee JH, Lee HJ, Choe YH. Spontaneous passage of gastrointestinal foreign bodies in children. Korean J Pediatr Gastroenterol Nutr 2007; 10: 157-65
• 6 Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: An analysis of 2382 cases. Pediatrics 1992; 89: 747-57
• 7 Pellerin D, Fortier-Beaulieu M, Gueguen J. The fate of swallowed foreign bodies experience of 1250 instances of sub-diaphragmatic foreign bodies in children. Program Pediatr Radiol 1969; 2: 286-302
• 8 ASGE Standards of Practice Committee. Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S. et al Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011; 73: 1085-91
• 9 Sugawa C, Ono H, Taleb M, Lucas CE. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A review. World J Gastrointest Endosc 2014; 6: 475-81
• 10 Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: Retrospective analysis of 542 cases. World J Surg 1996; 20: 1001-5
• 11 Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-body ingestion: Characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc 2009; 69: 426-33
• 12 Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC. et al Management of ingested foreign bodies in children: A clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60: 562-74
• 13 Chen X, Milkovich S, Stool D, Van As AB, Reilly J, Rider G. Pediatric coin ingestion and aspiration. Int J Pediatr Otorhinolaryngol 2006; 70: 325-9
• 14 Dhawan SS, Ryder KM, Pritchard E. Massive penny ingestion: The loot with local and systemic effects. J Emerg Med 2008; 35: 33-7
• 15 Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: An analysis of 8648 cases. Pediatrics 2010; 125: 1178-83
• 16 Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z. Endoscopic management of foreign bodies in the upper-GI tract: Experience with 1088 cases in China. Gastrointest Endosc 2006; 64: 485-92
• 17 Zhang S, Cui Y, Gong X, Gu F, Chen M, Zhong B. Endoscopic management of foreign bodies in the upper gastrointestinal tract in South China: A retrospective study of 561 cases. Dig Dis Sci 2010; 55: 1305-12
• 18 Mosca S, Manes G, Martino R, Amitrano L, Bottino V, Bove A. et al Endoscopic management of foreign bodies in the upper gastrointestinal tract: Report on a series of 414 adult patients. Endoscopy 2001; 33: 692-6
• 19 Athanassiadi K, Gerazounis M, Metaxas E, Kalantzi N. Management of esophageal foreign bodies: A retrospective review of 400 cases. Eur J Cardiothorac Surg 2002; 21: 653-6
• 20 Gmeiner D, Von Rahden BH, Meco C, Hutter J, Oberascher G, Stein HJ. Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus. Surg Endosc 2007; 21: 2026-9
• 21 Webb WA. Management of foreign bodies of the upper gastrointestinal tract: Update. Gastrointest Endosc 1995; 41: 39-51
• 22 Cheng W, Tam PK. Foreign-body ingestion in children: Experience with 1265 cases. J Pediatr Surg 1999; 34: 1472-6