Abstract

GONZALEZ, Mauricio; GOMEZ, Martín  and  OTERO, William. Foreign bodies in the esophagus. Rev Col Gastroenterol [online]. 2006, vol.21, n.3, pp.150-161. ISSN 0120-9957.

Introduction. Foreign bodies (FB) in the esophagus (FBE) is one of the most frequent emergency consultations in the gastroenterology service and involves in its management specialties such as: surgery, otolaryngology and radiology. The type of foreign body and its incidence varies according to the geographical region and the age of the patients. There is controversy on the predictive value of the symptoms and the final finding of a foreign body. Likewise, the initial Management protocol and the endoscopic intervention vary. Materials and methods. Descriptive observational case-series study. Study performed from July 2004 to January 2006, Patients more than one year of age were included in the study, with clinical suspicion of Foreign body, attended at El Tunal hospital, be it because they consulted to this institution or because they wear referred from other centers belonging to the health district network, covering patient population of the socioeconomic layers 1 to 3. Suspicion of impaction less than seven days of evolution. Exclusion criteria. Patients less than one year old, and those not accepting to participate in the study. All of the patients were filled out a form including the target measurement variables. The objectives were as follows: 1. To determine the clinical useful parameters to predict if a foreign body is found during the higher digestive endoscopy. 2. Establish the frequency and location of the various foreign bodies. 3. Determine the efficacy of flexible endoscopy for extracting foreign bodies lodged in the esophagus. Results. 110 patients were included in the study, 50% of them male. Age span ranged from 1 to 79 o seven years old. 15% were less than 10 years old. In 60 of them a foreign body was found. The patients presented to the hospital 2 to 72 hours after initiation and upper GI tract endoscopy was performed within 12 hours after admission. The most frequent site of impaction was the upper esophagus, 58% (35/60), followed by the hypopharynx in 22% of cases (13/60). Fish bones were found in both sites with equal frequency. Coins were only found in patients less than five years old. Cervical X-rays were 64% sensitive and 100% specific in those cases. Dysphagia, aphagia and sialorrhea had low sensitivity and high specificity in 97% of the cases of Foreign body could be extracted with flexible endoscopy using a foreign body extraction forceps. Conclusions. The most frequent impaction sites for foreign bodies are the upper esophagus and the hypopharynx. Sialorrhea, aphagia and dysphagia are highly specific but are low sensitive. Neck radiographs have intermediate sensitivity but high specificity. Upper GI endoscopy with flexible equipment is an excellent diagnostic and therapeutic method.

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