Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions

Objectives and StudyAccidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed.MethodsA 33-item REDCap (c) survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations.ResultsDuring 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing <= 3 patients with RIFBI within the past 24 months and 4% reported seeing >= 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was >= 5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings.ResultsDuring 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing <= 3 patients with RIFBI within the past 24 months and 4% reported seeing >= 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was >= 5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings.ConclusionMost gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported. image RIFBI in adults is associated with psychiatric comorbidity, increased treatment complications, and high treatment cost Little is known about RIFBI in pediatrics and how intentional ingestion impacts endoscopic managementWhat is New Our international survey suggests that while prevalence of RIFBI in pediatrics is low, reoccurrence is high (e.g., 1/3 respondents reported seeing RIFBI patients presenting with >= 5 ingestions annually) Psychiatric comorbidities, including multiple morbidities, are overwhelmingly present in pediatric RIFBI High rates of morbidity are reported in treatment of RIFBI Coordinated multidisciplinary care, including behavioral health, may help to reduce recurrence