GASTROENTEROLOGY ARTICLE OF THE WEEK
August 8, 2002
ASGE. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802-806.
1. Impacted food boluses
a. require emergent endoscopy regardless of patient status
b. endoscopy may be delayed up to 24 hours in those who can handle their
secretions and are not in distress
c. upon encountering the food bolus, the endoscope should be used to
vigorously push the food bolus into the stomach
d. the use of papain or meat tenderizer increases the success of endoscopy in
removing a food bolus.
e. glucagon 1.0mg IV may be a useful measure in promoting spontaneous
passage of the bolus.
2. Objects readily seen on plain radiographs include
a. steak bones
b. fish bones
c. chicken bones
d. coins
e. glass
d. wood
3. Blunt objects that have entered the stomach
a. endoscopy is not always necessary
b. objects >2.5 cm in diameter or width are less likely to cross the pylorus
c. If the object fails to leave the stomach in 3 to 4 weeks, endoscopy is indicated
d. in asymptomatic patients, weekly radiographs should be done to monitor
progress
e. once the object passes the stomach, surgery is indicated if the object stays in
the same position for > 1 week.
f. patients should remain on a liquid diet until the foreign object is excreted.
True or false
4. The two anatomic areas in the GI tract that are predisposed to perforation from foreign objects are the cricopharyngeus muscle and the ileocecal valve.
5. Narcotic packets lodged in the stomach should be removed by endoscopy.
6. A barium swallow should be the initial test of choice when a foreign object is thought to be located in the esophagus.
7. A small (<20mm diameter) disk or button battery that has entered the stomach should be removed by endoscopy immediately
8. Objects longer than 6 to 10 cm are less likely to pass the duodenal sweep and should be removed by endoscopy.
9. If an object is lodged in the esophagus and the patient is in no distress, observation for 72 hours is warranted.
10. If a sharp object fails to progress on serial X-rays over 3 days, surgery should be performed, even if the patient is asymptomatic.
11. The risk of complications from a sharp object that is not retrieved can be as high as 35%