Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA.
Dis Esophagus. 2020 May 15;33(5). doi: 10.1093/dote/doz103.
Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients' admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki's ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P < 0.001). EFBI-related esophageal adverse events (AEs) occurred in 4.9% of cases. Cardiovascular and pulmonary AEs occurred in 1.5 and 2.9%, respectively. Logistic regression did not find any predictor for AEs occurrence. EFBI managed very well with endoscopic treatments. Despite the emerging data about the safety of the push technique, there are still concerns regarding its adverse events especially the risk of perforations. Our study shows no significant difference in adverse events between different types of techniques.
食管异物嵌顿（EFBI）是一种胃肠道急症，主要需要内镜治疗。本研究旨在评估 EFBI 发作后患者的流行病学、不良事件和结局。回顾了 2003 年至 2018 年期间堪萨斯大学医学中心因 EFBI 住院的所有食管胃十二指肠镜（EGD）报告。在 204 名符合纳入标准的患者中，60%为男性，平均年龄为 54.7±17.7 岁。76%的病例为 EFBI 的首次发作。79%的病例需要在入院后 24 小时内进行 EGD。最常见的嵌顿部位是食管下段（44%）。分别有 38%和 35.2%的病例使用推压技术和拉拔技术，11%的病例采用两种技术的联合治疗。结构原因是最常见的病因学发现，包括良性狭窄和狭窄占 21.5%的患者，其次是 Schatzki 环（7.8%）和食管裂孔疝（6.9%）。所有病例中，45%的患者在 1 年内进行了随访，34%的患者进行了活检。在 43 例内镜检查发现疑似嗜酸性食管炎（EoE）的患者中，有 37 例通过病理检查得到确诊。EoE 患者 EFBI 复发率明显更高（P<0.001）。EFBI 相关食管不良事件（AE）发生率为 4.9%。心血管和肺部 AE 的发生率分别为 1.5%和 2.9%。逻辑回归未发现 AE 发生的任何预测因素。EFBI 经内镜治疗效果良好。尽管关于推压技术安全性的新数据不断出现，但人们仍对其不良事件，尤其是穿孔风险存在担忧。我们的研究表明，不同类型的技术之间不良事件发生率没有显著差异。
