Singleton Jennifer, Schafer Jesse M, Hinson Jeremiah S, Kane Erin M, Wright Sherieka, Hoffmann Beatrice
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, United States.
Department of Emergency Medicine, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Baltimore, MD 21287, United States.
Am J Emerg Med. 2017 May;35(5):720-724. doi: 10.1016/j.ajem.2017.01.008. Epub 2017 Jan 11.
Esophageal foreign body (EFB) and impaction are common gastrointestinal emergencies. Detection with standard imaging can be challenging. Computed tomography is a commonly used non-invasive imaging modality, but is not 100% sensitive and not always feasible. Sensitivity of plain film x-ray varies widely and the addition of a barium swallow can obscure evaluation by subsequent esophagogastroduodenoscopy (EGD). Use of emergency ultrasound (EUS) for detection of EFB in adults has not been previously studied.
To evaluate the role of EUS in detection of EFB and to characterize sonographic findings.
A case control series of five patients with clinical suspicion of EFB underwent EUS, and findings were compared to five healthy controls. Patients were evaluated for persistent air-fluid levels after swallowing, esophageal dilatation, and visualization of EFB.
All patients with suspected EFB had esophageal dilatation (17.5mm vs 9.3mm in healthy controls; p=0.0011) and persistent air-fluid levels after swallowing. EFB was visualized on EUS in 60% of patients. All patients had EFB confirmed on EGD except one, who vomited a significant food bolus during EUS and prior to EGD.
In patients with suspected EFB, point-of-care ultrasound may identify those with impaction. Suggestive findings include cervical esophageal dilatation and persistent intraluminal air-fluid levels after swallowing. EUS is a rapid, convenient test with the potential to expedite definitive management while decreasing cost and radiation exposure in this patient population.
食管异物（EFB）及嵌塞是常见的胃肠道急症。用标准影像学方法进行检测可能具有挑战性。计算机断层扫描是常用的非侵入性成像方式，但并非100%敏感，且并非总是可行。普通X线平片的敏感性差异很大，而吞钡检查会使后续的食管胃十二指肠镜检查（EGD）难以进行评估。此前尚未对成人使用急诊超声（EUS）检测EFB进行研究。
评估EUS在检测EFB中的作用，并描述超声检查结果。
对5例临床怀疑有EFB的患者进行病例对照系列研究，接受EUS检查，并将结果与5名健康对照者进行比较。对患者吞咽后持续存在的气液平面、食管扩张情况以及EFB的可视化情况进行评估。
所有疑似EFB的患者均有食管扩张（健康对照者为9.3mm，患者为17.5mm；p = 0.0011），且吞咽后有持续的气液平面。60%的患者在EUS上可见EFB。除1例患者外，所有患者在EGD检查中均确诊有EFB，该例患者在EUS检查期间及EGD检查之前吐出了大量食团。
对于疑似EFB的患者，床旁超声可能识别出有嵌塞的患者。提示性表现包括颈段食管扩张以及吞咽后管腔内持续存在的气液平面。EUS是一种快速、便捷的检查，有可能加快确定性治疗，同时降低该患者群体的费用和辐射暴露。
