Management of ingested foreign objects and food bolus impactions,☆☆,,★★,

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Abstract

This review article is intended to aid the clinician in the evaluation and management of older children and adult patients with possible foreign object ingestion and/or food bolus impaction. A literature search was performed in June 1993 on the Medline using Medlars II, the National Library of Medicine's National Interactive Retrieval Service. This search generated 181 citations. References chosen for review were English-language citations from the gastroenterology, otolaryngology, general surgical, and radiological literature. As little or no data exist from well-designed prospective trials, emphasis was given to results from large series. In preparing this manuscript several drafts were distributed to the members of the American Society for Gastrointestinal Endoscopy, Standards of Practice Committee, and to national experts on the subject for critical review. (Gastrointest Endosc 1995;41:33-8.)

Section snippets

History and physical examination

In older children and fully conscious, communicative adults, foreign object ingestion may be recognized at the time of the incident and this history conveyed to the physician. The patient may be able to identify the material swallowed and point to the location of discomfort. Patient localization of the level of impaction, however, is not reliable.10 Conversely, in many instances the ingestion goes unrecognized or unreported until the onset of symptoms, which may be delayed hours, days, to even

General

Once a foreign body ingestion is diagnosed, the physician must decide whether or not intervention is necessary, what degree of urgency is called for, and by what best available means. The decision to intervene endoscopically in the management of an ingested foreign body is influenced by the patient's age and clinical condition; the size, shape, and classification of the ingested material; the anatomic location in which the object is lodged; and the technical abilities of the endoscopist.8

The

Acknowledgements

The author thanks David E. Fleischer, MD, Stanley B. Benjamin, MD, and William A. Webb, MD, for their critical review of this manuscript. A draft was distributed to the members of the American Society for Gastrointestinal Endoscopy, Standards of Practice Committee (Gregory Zuccaro Jr., MD, Damian H. Augustyn, MD, Richard D. Baerg, MD, W. Scott Brooks, Jr., MD, D. Roy Ferguson, MD, Peter R. McNally, MD, and John L. Petrini, MD) for critical review and commentary.

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      However, this concern has not been evaluated in large series or utilizing atraumatic techniques. Objects generally impact, perforate, or obstruct the gastrointestinal tract at areas of sharp angulation, change in caliber, or at narrowed locations, including the upper esophageal sphincter (UES), lower esophageal sphincter (LES)/gastroesophageal junction, pylorus, duodenal sweep, ileocecal valve, and the rectum/anus [12]. Without an underlying pathologic condition, each of these points has a luminal narrowing to 23 mm or less [13].

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    From the Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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    Reprint requests: Gregory G. Ginsberg, MD, Hospital of the University of Pennsylvania, Gastroenterology Division, 3 Dulles Building, 3400 Spruce St., Philadelphia, PA 19104.

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