Foreign body ingestion is associated with an estimated 1,500 to 1,600 deaths annually in the US and is the second most common indication for emergency gastrointestinal endoscopy after hemorrhage. A narrative review published in Gastro Research examined epidemiology, imaging, and management of foreign bodies in the gastrointestinal tract through a narrative synthesis of clinical references and practice guidance without a preregistered protocol, predefined inclusion criteria, and original patient-level data.

The article collated risk groups, anatomic sites of impaction, imaging pathways, and size- and time-based thresholds. Most ingested objects passed spontaneously within 48 hours to 1 month. High-risk populations include young children, edentulous adults, patients who are intoxicated, and those with cognitive impairment. The review localized impaction to physiologic esophageal narrowings—the cricopharyngeal muscle, aortic arch, left main bronchus, and gastroesophageal junction—with the cervical esophagus implicated in 57% of cited impactions. Diagnostic strategy began with plain radiographs for radiopaque items, whereas wood, plastic, glass, and fish or poultry bones often required computed tomography for localization. Early endoscopy was advised when impaction was suspected; inability to swallow saliva indicated complete esophageal obstruction. Once an object traversed the upper esophageal sphincter—the narrowest segment of the gastrointestinal tract—uneventful passage was typical unless distal strictures or postsurgical narrowings were present.

Hazard-specific thresholds were prominent. Button batteries can conduct current and cause rapid full-thickness necrosis; when lodged in the esophagus, the treatment window may be as brief as 4 hours, after which risks of tracheoesophageal fistula, vascular erosion with massive hemorrhage, and stricture increase sharply. “In the event that the foreign body is held up within the esophagus, the window for determination and evacuation may be as brief as 4 hours, after which the chance of complication rises drastically,” noted the researcher Sinisa Franjic of Bosnia and Herzegovina. High-power magnets were identified as an urgent special case in the review. Sharp objects longer than 3 cm, items with a diameter greater than 2 cm, and objects longer than 5 cm were unlikely to pass the pylorus or duodenum, respectively. Approximately 85% of batteries beyond the duodenum passed within 72 hours.

The researcher did not report any relevant conflicts of interest.

Source: Gastro Research