Emergency Department, Taipei Veterans General Hospital, Taiwan.
Am J Med Sci. 2012 Mar;343(3):192-5. doi: 10.1097/MAJ.0b013e3182263035.
The objective is to evaluate the diagnosis of foreign body (FB) ingestion and report on the endoscopic management in Taiwan.
This retrospective study enrolled 159 adult patients with confirmed diagnosis of upper gastrointestinal FBs who received endoscopic management in the emergency department.
The patients' mean age was 57.0 ± 19.2 years, and 66 (37.7%) of the patients were 65 years or older. Majority had a clear history and symptoms of FB ingestion. However, 9 (5.7%) initially ignored the accidental swallowing of FBs and were diagnosed late. The mean time spent for diagnosis was 1.8 days in those with uncertain history. Only 47.1% of those with radiographic studies had positive findings. Fish bones, press-through package and dentures were the most common culprits in this population of Asian elderly. Majority of FBs were located in the esophagus, especially in the upper third. Endoscopic FB extraction was successful in 96.9% of cases, while surgery was required in only 5 patients. The complication rate was 6.9%, including mucosal laceration (n = 10) and suspected perforation (n = 1), all of which were successfully managed conservatively. There was no death due to FB ingestion or endoscopy.
In FB ingestion, history usually points toward the diagnosis. Patients with an uncertain history are usually diagnosed late, and plain radiography cannot reliably predict the presence of FB. Endoscopic management is safe and effective for FBs.
本研究旨在评估食入异物（FB）的诊断，并报告台湾地区的内镜处理情况。
本回顾性研究纳入了 159 例经内镜确诊为上消化道 FB 的成年患者，这些患者均在急诊科接受了内镜处理。
患者的平均年龄为 57.0 ± 19.2 岁，其中 66 例（37.7%）患者年龄≥65 岁。大多数患者有明确的 FB 食入史和症状。然而，有 9 例（5.7%）患者最初忽视了意外吞食 FB，导致诊断较晚。对病史不确定的患者，平均诊断时间为 1.8 天。仅有 47.1%的行影像学检查的患者有阳性发现。鱼骨、压穿包装和义齿是该老年亚洲人群中最常见的异物原因。大多数 FB 位于食管，尤其是食管上段。96.9%的 FB 采用内镜取出术成功取出，仅 5 例患者需要手术。并发症发生率为 6.9%，包括黏膜撕裂伤（n = 10）和疑似穿孔（n = 1），所有并发症均经保守治疗成功处理。无因 FB 食入或内镜检查导致的死亡病例。
在 FB 食入中，病史通常有助于诊断。对病史不确定的患者通常诊断较晚，且普通 X 线摄影不能可靠预测 FB 的存在。内镜处理是安全有效的 FB 处理方法。
