gastrointestinal disorders
Esophageal Foreign Bodies
Treatment of Esophageal Foreign Bodies
Sometimes trial of observation and/or IVglucagon Often endoscopic removal Some foreign bodies pass spontaneously into the stomach, after which they typically pass completely through the gastrointestinal tract and are expelled. Patients without symptoms of high-grade obstruction and without ingestion of sharp objects or disk or button batteries typically can safely be observed for up to 24 hours to await passage, which is indicated by relief of symptoms. Administration ofglucagon1 mg IV is a relatively safe and acceptable option that sometimes allows for spontaneous passage of a food bolus by relaxing the distal esophagus. Other methods, such as use of effervescent agents, meat tenderizer, and bougienage, are not recommended. Foreign bodies that do not pass within 24 hours ( Treatment references ) should be removed because delay increases the risk of complications, including perforation, and decreases the likelihood of successful removal. Endoscopic advancement of the bolus into the stomach or removal is the treatment of choice. Endoscopic advancement is preceded by trying to pass the endoscope around the food bolus and examining the esophagus distal to the bolus (eg, for luminal narrowing or obstructing lesions) and then accomplished by applying gentle pressure to the middle of the food bolus. To minimize the risk of perforation, this procedure should be done only by an experienced endoscopist. Removal is best achieved using a forceps, multiprong graspers, net, basket, or snare, preferably with an overtube placed in the esophagus or Tracheal Intubation to prevent aspiration and protect the airway ( Emergent endoscopy is required for sharp-pointed objects, disk or button batteries, and any obstruction causing significant symptoms. Follow-up care for the evaluation of structural and functional abnormalities is recommended for patients with esophageal food impaction. Treatment for obstruction due to packets of illicit drugs is done by surgical intervention, as endoscopic intervention is contraindicated due to risk of rupture of the packaging and drug overdose, though in select cases endoscopic removal can be considered in a multidisciplinary setting with surgery on board and ready for intervention if any package rupture occurs. 