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Endoscopy: Alternative To Surgery For Foreign Object Removal From Gastrointestinal Tract

Armen Hareyan's picture

Foreign Object Removal From Gastrointestinal Tract

Foreign object ingestion is more common than people think, and while the majority of objects swallowed occur among children, it also happens to adults, primarily those with psychiatric disorders and the mentally handicapped.

The recent recall of toys containing small magnets that can come loose and be swallowed by young children highlights the risk of serious injury when foreign objects are ingested. The majority of foreign objects, 80 percent, that reach the gastrointestinal tract will pass naturally and not require treatment. Ten to 20 percent, however, will require nonoperative intervention, while one percent or less will require surgery. Endoscopy is safe and effective in treating patients who have swallowed a foreign object that will not pass naturally.

"Seeking medical attention immediately after a person has swallowed a foreign object is vital in preventing complications and reducing injury. Symptoms include choking, chest pain, abdominal pain, respiratory symptoms, and vomiting," said Marsha Kay, MD, spokesperson for the American Society for Gastrointestinal Endoscopy and pediatric gastroenterologist at the Cleveland Clinic. "Once a physician has made the diagnosis, they will decide if the object can pass through the body without intervention or if removal is necessary immediately. When intervention is required, endoscopy is a noninvasive and effective method for removal of the object."

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Serious complications and even death can occur when a foreign object is swallowed and not treated immediately. The recent toy recall highlights the dangers caused when small magnets are swallowed by children. If more than one magnet is swallowed, they can attract each other and cause intestinal perforation, fistulas (holes) or blockage, which can be fatal. If the magnets are in the esophagus, stomach or duodenum (just below the stomach), retrieval is done endoscopically through the throat. Magnets in the lower part of the small intestine or in the large intestine must be removed surgically if they do not pass safely.

In 2005, nearly 111,000 ingestions of foreign objects by people 19 and under were reported to the American Poison Control Centers. Both children and adults may accidentally ingest foreign objects, including coins (the most common object swallowed by children), batteries, toys, pins, and food such as pieces of meat or bones (chicken or fish). These items may get stuck or lodged at various locations in the gastrointestinal tract and all require removal. Other objects require removal even if they are not stuck due to their potential to cause injury. Examples include batteries lodged in the esophagus, and sharp or large foreign objects of any kind.

Some foreign objects do not require removal and may pass on their own under physician supervision. Because recommendations for therapy vary based on the patient's age, size, type of object, its location in the body and symptoms, individuals should contact their physician or gastroenterologist in every case of foreign object ingestion. A coin in the stomach should pass harmlessly in four to six days, but if it has not passed into the stomach within 12 to 24 hours and stays in the esophagus, endoscopy should be used to remove it. If a patient cannot swallow or is experiencing acute respiratory symptoms, the coin should be removed immediately.

The presence and location of a foreign object may be determined by X-ray. Sometimes the foreign object is not visible by X-ray and requires an endoscopic procedure for diagnosis. In addition to diagnostic purposes, endoscopy is used as a noninvasive alternative to surgery for removal of foreign objects. Removal may be done by both upper endoscopy and colonoscopy, depending on their location.

Battery ingestion is also common among young children in the U.S. and in individuals with psychiatric disorders, and often does not present symptoms. It is especially dangerous and can cause death if lodged in the esophagus given the caustic material within it and the potential for discharging of current. Leakage of battery contents in the esophagus can cause burns, therefore endoscopic removal of the battery is warranted immediately.

Among adolescents and adults, ingestion of sharp objects such as pins, razor blades and nails is often done intentionally, and has a high risk of complications at ingestion as well as during removal. Endoscopic removal may be required immediately in these cases as well.