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Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines

  • Kaan Demiroren (Department of Pediatric Gastroenterology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital)
  • Received : 2022.06.25
  • Accepted : 2022.08.30
  • Published : 2023.01.15

Abstract

Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithiumion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.

Keywords

References

  1. 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.  https://doi.org/10.1097/MPG.0000000000000729
  2. Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy guidelines. J Pediatr Gastroenterol Nutr 2017;64:133-53.  https://doi.org/10.1097/MPG.0000000000001408
  3. Birk M, Bauerfeind P, Deprez PH, Hafner M, Hartmann D, Hassan C, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48:489-96.  https://doi.org/10.1055/s-0042-100456
  4. 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.  https://doi.org/10.1016/j.gie.2010.11.010
  5. Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, et al. Foreign body and caustic ingestions in children: a clinical practice guideline. Dig Liver Dis 2020;52:1266-81.  https://doi.org/10.1016/j.dld.2020.07.016
  6. Kurowski JA, Kay M. Caustic ingestions and foreign bodies ingestions in pediatric patients. Pediatr Clin North Am 2017;64:507-24.  https://doi.org/10.1016/j.pcl.2017.01.004
  7. Gregori D, Scarinzi C, Morra B, Salerni L, Berchialla P, Snidero S, et al. Ingested foreign bodies causing complications and requiring hospitalization in European children: results from the ESFBI study. Pediatr Int 2010;52:26-32.  https://doi.org/10.1111/j.1442-200X.2009.02862.x
  8. Aydogdu S, Arikan C, Cakir M, Baran M, Yuksekkaya HA, Saz UE, et al. Foreign body ingestion in Turkish children. Turk J Pediatr 2009;51:127-32. 
  9. Sink JR, Kitsko DJ, Mehta DK, Georg MW, Simons JP. Diagnosis of pediatric foreign body ingestion: clinical presentation, physical examination, and radiologic findings. Ann Otol Rhinol Laryngol 2016;125:342-50.  https://doi.org/10.1177/0003489415611128
  10. Chotigavanich C, Ballali S, Foltran F, Passali D, Bellussi L, Gregori D; ESFBI Study Group. Foreign bodies injuries in children: analysis of Thailand data. Int J Pediatr Otorhinolaryngol 2012;76 Suppl 1:S80-3.  https://doi.org/10.1016/j.ijporl.2012.02.019
  11. Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. 2019 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th annual report. Clin Toxicol (Phila) 2020;58:1360-541.  https://doi.org/10.1080/15563650.2020.1834219
  12. Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z. Endoscopic management of foreign bodies in the upperGI tract: experience with 1088 cases in China. Gastrointest Endosc 2006;64:485-92.  https://doi.org/10.1016/j.gie.2006.01.059
  13. Antoniou D, Christopoulos-Geroulanos G. Management of foreign body ingestion and food bolus impaction in children: a retrospective analysis of 675 cases. Turk J Pediatr 2011;53:381-7. 
  14. Limpias Kamiya KJ, Hosoe N, Takabayashi K, Hayashi Y, Sun X, Miyanaga R, et al. Endoscopic removal of foreign bodies: a retrospective study in Japan. World J Gastrointest Endosc 2020;12:33-41.  https://doi.org/10.4253/wjge.v12.i1.33
  15. Houston R, Powell S, Jaffray B, Ball S. Clinical guideline for retained button batteries. Arch Dis Child 2021;106:192-4.  https://doi.org/10.1136/archdischild-2019-318354
  16. Horowitz R, Cico SJ, Bailitz J. Point-of-care ultrasound: a new tool for the identification of gastric foreign bodies in children? J Emerg Med 2016;50:99-103.  https://doi.org/10.1016/j.jemermed.2015.07.022
  17. van Wassenaer EA, Daams JG, Benninga MA, Rosendahl K, Koot BGP, Stafrace S, et al. Non-radiologist-performed abdominal point-of-care ultrasonography in paediatrics - a scoping review. Pediatr Radiol 2021;51:1386-99. https://doi.org/10.1007/s00247-021-04997-x
  18. Le Coz J, Orlandini S, Titomanlio L, Rinaldi VE. Point of care ultrasonography in the pediatric emergency department. Ital J Pediatr 2018;44:87. 
  19. Little DC, Shah SR, St Peter SD, Calkins CM, Morrow SE, Murphy JP, et al. Esophageal foreign bodies in the pediatric population: our first 500 cases. J Pediatr Surg 2006;41:914-8.  https://doi.org/10.1016/j.jpedsurg.2006.01.022
  20. Celik S, Aydemir B, Tanrikulu H, Okay T, Dogusoy I. [Esophageal foreign bodies in children and adults: 20 years experience]. Ulus Travma Acil Cerrahi Derg 2013;19:229-34. Turkish.  https://doi.org/10.5505/tjtes.2013.22687
  21. Fang Y, Qin Z. Comparison of endoscopy alone with surgery converted from endoscopy for the removal of esophageal foreign bodies in adults: a retrospective study from a single center. Med Sci Monit 2021;27:e929142. 
  22. Oncel M, Sunam GS, Elsurer C, Yildiran H. Use of Magill forceps to remove foreign bodies in children. Surg J (N Y) 2017;3:e91-5.  https://doi.org/10.1055/s-0037-1604102
  23. Baral BK, Joshi RR, Bhattarai BK, Sewal RB. Removal of coin from upper esophageal tract in children with Magill's forceps under propofol sedation. Nepal Med Coll J 2010;12:38-41. 
  24. Harned RK 2nd, Strain JD, Hay TC, Douglas MR. Esophageal foreign bodies: safety and efficacy of Foley catheter extraction of coins. AJR Am J Roentgenol 1997;168:443-6.  https://doi.org/10.2214/ajr.168.2.9016224
  25. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010;125:1168-77.  https://doi.org/10.1542/peds.2009-3037
  26. Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 2010;125:1178-83.  https://doi.org/10.1542/peds.2009-3038
  27. Leinwand K, Brumbaugh DE, Kramer RE. Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. Gastrointest Endosc Clin N Am 2016;26:99-118.  https://doi.org/10.1016/j.giec.2015.08.003
  28. Al Lawati TT, Al Marhoobi RM. Timing of button battery removal from the upper gastrointestinal system in children. Pediatr Emerg Care 2021;37:e461-3.  https://doi.org/10.1097/PEC.0000000000001697
  29. Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH. Foreign body ingestion in children: should button batteries in the stomach be urgently removed? Pediatr Gastroenterol Hepatol Nutr 2016;19:20-8.  https://doi.org/10.5223/pghn.2016.19.1.20
  30. Mubarak A, Benninga MA, Broekaert I, Dolinsek J, Homan M, Mas E, et al. Diagnosis, management, and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. J Pediatr Gastroenterol Nutr 2021;73:129-36.  https://doi.org/10.1097/MPG.0000000000003048
  31. Akilov KA, Asadullaev DR, Yuldashev RZ, Shokhaydarov SI. Cylindrical and button battery ingestion in children: a single-center experience. Pediatr Surg Int 2021;37:1461-6.  https://doi.org/10.1007/s00383-021-04953-8
  32. Cyrany J, Melek J, Dedek P, Toms J, Rejchrt S. Cylindrical battery ingested by a 1-year-old baby - does the voltage matter? Endoscopy 2014;46 Suppl 1 UCTN:E543-4.  https://doi.org/10.1055/s-0034-1377772
  33. Middelberg LK, Funk AR, Hays HL, McKenzie LB, Rudolph B, Spiller HA. Magnet injuries in children: an analysis of the National Poison Data System from 2008 to 2019. J Pediatr 2021;232:251-6.e2.  https://doi.org/10.1016/j.jpeds.2021.01.052
  34. Rosenfield D, Strickland M, Hepburn CM. After the recall: reexamining multiple magnet ingestion at a large pediatric hospital. J Pediatr 2017;186:78-81.  https://doi.org/10.1016/j.jpeds.2017.02.002
  35. Miyamoto R, Okuda M, Kikuchi S, Iwayama H, Hataya H, Okumura A. A nationwide questionnaire survey on accidental magnet ingestion in children in Japan. Acta Paediatr 2021;110:314-25.  https://doi.org/10.1111/apa.15428
  36. Sola R Jr, Rosenfeld EH, Yu YR, St Peter SD, Shah SR. Magnet foreign body ingestion: rare occurrence but big consequences. J Pediatr Surg 2018;53:1815-9.  https://doi.org/10.1016/j.jpedsurg.2017.08.013
  37. Deveci U, Bakal u, Dogan Y. Foreign body in liver: sewing needle. Turk J Gastroenterol 2014;25:737-8.  https://doi.org/10.5152/tjg.2014.14093
  38. Tee WQ, Chang YL, Kuo PJ, Kang CH. Necrotizing fasciitis from an iliopsoas muscle abscess caused by a toothpick: a case report and literature review. Int J Surg Case Rep 2020;76:463-7.  https://doi.org/10.1016/j.ijscr.2020.10.009
  39. Harhar M, Jabi R, El Harroudi T, Bouziane M. Fishbone-induced appendicitis: a case report. Cureus 2021;13:e15003. 
  40. Enes Silva J, Pinelas S, Pacheco M, Patacho M, Almeida J. Gastric perforation by fish bone with hepatic abscess formation presenting as prolonged fever. IDCases 2021;24:e01159. 
  41. Elbakouri A, Yaqine K, Bouali M, Elhattabi K, Bensardi F, Fadil A. Fish bone perforation of the small bowel: a case report. Ann Med Surg (Lond) 2021;65:102348. 
  42. Ojio H, Tanaka Y, Sato Y, Imai T, Okumura N, Matsuhashi N, et al. A case of submucosal abscess of the esophagus mimicking a mediastinal abscess. Clin J Gastroenterol 2021;14:402-6.  https://doi.org/10.1007/s12328-020-01299-x
  43. Liu YH, Lv ZB, Liu JB, Sheng QF. Perianorectal abscesses and fistula due to ingested jujube pit in infant: two case reports. World J Clin Cases 2020;8:4930-7.  https://doi.org/10.12998/wjcc.v8.i20.4930
  44. Wang S, Liu J, Chen Y, Yang X, Xie D, Li S. Diagnosis and treatment of nine cases with carotid artery rupture due to hypopharyngeal and cervical esophageal foreign body ingestion. Eur Arch Otorhinolaryngol 2013;270:1125-30.  https://doi.org/10.1007/s00405-012-2138-9
  45. Zhang X, Liu J, Li J, Hu J, Yu F, Li S, et al. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope 2011;121:267-72.  https://doi.org/10.1002/lary.21366
  46. Cho MK, Lee MS, Han HY, Woo SH. Fish bone migration to the urinary bladder after rectosigmoid colon perforation. World J Gastroenterol 2014;20:7075-8.  https://doi.org/10.3748/wjg.v20.i22.7075
  47. Udemgba C, Missov E, Percy R, Sattiraju S. A case report of an unusual left atrial mass. Eur Heart J Case Rep 2021;5:ytaa500. 
  48. Pan S, Chai Y, Shen G. Recurrent pneumonia caused by a migrated esophageal foreign body. Thorac Cardiovasc Surg 2013;61:513-5.  https://doi.org/10.1055/s-0032-1331039
  49. Mulita F, Papadopoulos G, Tsochatzis S, Kehagias I. Laparoscopic removal of an ingested fish bone from the head of the pancreas: case report and review of literature. Pan Afr Med J 2020;36:123. 
  50. Bass RM, Hurshman LF, Winkler LF. Rupture of the carotid artery from a hypopharyngeal foreign body. Arch Otolaryngol 1978;104:471-3.  https://doi.org/10.1001/archotol.1978.00790080053015
  51. Sugunan S, Ajith Krishnan AS, Devakumar VK, Arif AK. Safety-pin induced hemopericardium and cardiac tamponade in an infant. Indian Pediatr 2018;55:521-2.  https://doi.org/10.1007/s13312-018-1345-x
  52. Cay A, Imamoglu M, Sarihan H, Sayil O. Duodenocolic fistula due to safety pin ingestion. Turk J Pediatr 2004;46:186-8. 
  53. Mirza B, Sheikh A. Open safety pin ingestion presenting as incarcerated umbilical hernia. APSP J Case Rep 2011;2:25. 
  54. Gun F, Salman T, Abbasoglu L, Celik R, Celik A. Safety-pin ingestion in children: a cultural fact. Pediatr Surg Int 2003;19:482-4.  https://doi.org/10.1007/s00383-003-0964-y
  55. Kalayci A, Tander B, Kocak S, Rizalar R, Bernay F. Removal of open safety pins in infants by flexible endoscopy is effective and safe. J Laparoendosc Adv Surg Tech A 2007;17:242-5.  https://doi.org/10.1089/lap.2006.0060
  56. Demiroren K. A case series of ingested open safety pin removal using a proposed endoscopic removal technique algorithm. Pediatr Gastroenterol Hepatol Nutr 2019;22:441-6.  https://doi.org/10.5223/pghn.2019.22.5.441
  57. Lim CW, Park MH, Do HJ, Yeom JS, Park JS, Park ES, et al. Factors associated with removal of impacted fishbone in children, suspected ingestion. Pediatr Gastroenterol Hepatol Nutr 2016;19:168-74.  https://doi.org/10.5223/pghn.2016.19.3.168
  58. Mirza B, Sheikh A. Mortality in a case of crystal gel ball ingestion: an alert for parents. APSP J Case Rep 2012;3:6. 
  59. Moon JS, Bliss D, Hunter CJ. An unusual case of small bowel obstruction in a child caused by ingestion of water-storing gel beads. J Pediatr Surg 2012;47:E19-22.  https://doi.org/10.1016/j.jpedsurg.2012.04.005
  60. Zamora IJ, Vu LT, Larimer EL, Olutoye OO. Water-absorbing balls: a "growing" problem. Pediatrics 2012;130:e1011-4.  https://doi.org/10.1542/peds.2011-3685
  61. Kim HB, Kim YB, Ko Y, Choi YJ, Lee J, Kim JH. A case of ingested water beads diagnosed with point-ofcare ultrasound. Clin Exp Emerg Med 2020;7:330-3.  https://doi.org/10.15441/ceem.20.041
  62. Fuger M, Desmoulins C, Khen Dunlop N, Gobbo F, Blakime P, Cheron G. Bowel obstruction due to ingestion of a water-absorbing bead. Arch Pediatr 2018;25:136-8.  https://doi.org/10.1016/j.arcped.2017.12.004
  63. Mehmetoglu F. A retrospective 10-year analysis of water absorbent bead ingestion in children. Emerg Med Int 2018;2018:5910527.