Management of esophageal foreign bodies: experience of 90 cases

Background. In Japan, there have been few recent reports of large-scale studies on the characteristics and optimal treatment of esophageal foreign bodies. Methods. We analyzed data on 90 patients diagnosed as having esophageal foreign bodies treated between April 2002 and August 2007. Results. In children younger than 15 years (n = 13), the types of foreign bodies included coins (n = 9), food (n = 1), and other objects (n = 3), 12 of which were successfully removed without endoscopic procedures; in the remaining 1 case, the object advanced to the lower digestive tract spontaneously. In adults aged 15 years or older (n = 77), the types of foreign bodies included food-bolus impaction (n = 26), press-through packages (n = 18), fish bones (n = 14), dental prostheses (n = 13), and other objects (n = 6). The foreign bodies had advanced to the lower digestive tract in 4 patients at the time of flexible endoscopy performed under topical pharyngeal anesthesia. In 6 of the remaining 73 patients, the first endoscopic extraction was unsuccessful, and 5 of these cases involved dental prostheses. The mean maximal size of the dental prosthesis was significantly greater in patients in whom removal was unsuccessful than in those in which it was successful (5.8 versus 1.6 cm, respectively; P < 0.05). The procedures employed following unsuccessful endoscopy included thoracotomy (n = 1), laparotomy (n = 1), removal by forceps under direct vision (n = 1), and rigid (n = 1), and flexible endoscopy (n = 2) under general anesthesia. Conclusions. The majority of esophageal foreign bodies were successfully removed nonendoscopically in pediatric patients and endoscopically in adult patients. Endoscopic removal under topical pharyngeal anesthesia may not be indicated for patients who have swallowed large dental prostheses.