Division of Gastroenterology and Liver Disease.
Clinical Research Development Office, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH.
J Clin Gastroenterol. 2023 Oct 1;57(9):890-894. doi: 10.1097/MCG.0000000000001789.
Endoscopic procedures for foreign body ingestion (FBI) and esophageal food impactions (EFI) performed during on-call hours are associated with increased stress, risk, and cost. We implemented a Foreign Body Algorithm (FBA) designed to delay all but the most urgent endoscopy for EFI and FBI until regular working hours.
Using endoscopy records from multiple academic and community hospitals within a large integrated health system in the United states, we identified esophagogastroduodenoscopy (EGD) performed for food impactions and foreign body ingestions occurring between May 2011 and February 2021.
We identified 479 EGDs performed for FBI and EFI. The introduction of the FBA was associated with a shorter length of stay (LOS) for overall cases (0.35 vs. 0.8 d P <0.001), day cases (0.16 vs. 1.0 d P <0.001), and night cases (0.40 vs. 0.6 d P =0.03). The introduction of the FBA did not change the rate of overall adverse events (AE) or night AE. AE from the entire cohort was rare (3%; 16 total). Of the AE, most were sedation related. The introduction of the FBA did not affect the overall rate of night cases or AE, but the rate of after-hours endoscopy for intentional ingestions decreased from 17.2% to 3.1% ( P =0.01).
This is one of the largest studies of esophageal impactions and foreign bodies in adults in the United States, and the first to examine the effects of a protocol designed to avoid after-hours endoscopy. These results suggest that postponing after-hours EGD until the daytime is not associated with adverse safety outcomes or increased LOS.
在值班期间进行的内镜下异物（FBI）和食管食物嵌塞（EFI）操作与增加的压力、风险和成本相关。我们实施了异物算法（FBA），旨在将除最紧急的 EFI 和 FBI 内镜检查之外的所有检查都推迟到正常工作时间进行。
使用美国一家大型综合医疗系统内多家学术和社区医院的内镜记录，我们确定了在 2011 年 5 月至 2021 年 2 月期间因食物嵌塞和异物摄入而进行的食管胃十二指肠镜检查（EGD）。
我们共确定了 479 例 FBI 和 EFI 的 EGD 检查。引入 FBA 与总病例（0.35 与 0.8d，P <0.001）、日间病例（0.16 与 1.0d，P <0.001）和夜间病例（0.40 与 0.6d，P =0.03）的住院时间（LOS）缩短相关。引入 FBA 并未改变总不良事件（AE）或夜间 AE 的发生率。整个队列的 AE 发生率很低（3%；共 16 例）。AE 中大多数与镇静相关。引入 FBA 并未影响夜间病例或 AE 的总体发生率，但故意摄入的夜间内镜检查率从 17.2%降至 3.1%（P =0.01）。
这是美国成人食管嵌塞和异物的最大研究之一，也是首次研究旨在避免夜间内镜检查的方案的影响。这些结果表明，将夜间 EGD 推迟到白天进行不会导致不良安全结果或增加 LOS。
