Department of Gastroenterology and Hepatology, Alfred Health, Melbourne, Victoria, Australia
Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia.
BMJ Open Gastroenterol. 2023 Feb;10(1). doi: 10.1136/bmjgast-2022-001087.
Foreign body ingestion (FBI) occurs infrequently but can be associated with rare risks including perforation. There is limited understanding of the impact of adult FBI in Australia. We aim to evaluate patient characteristics, outcomes and hospital costs of FBI.
A retrospective cohort study of patients with FBI was performed at a non-prison referral centre in Melbourne, Australia. International Classification of Disease-10 coding identified patients with gastrointestinal FBI over financial years 2018-2021. Exclusion criteria were food bolus, medication foreign body, object in anus or rectum, or non-ingestion. Criteria for 'emergent' classification were oesophagus, size >6 cm, disc batteries, airway compromise, peritonitis, sepsis and/or suspected viscus perforation.
Thirty-two admissions attributed to 26 patients were included. The median age was 36 years (IQR: 27-56), 58% were male and 35% had a prior psychiatric or autism spectrum disorder. There were no deaths, perforations or surgery. Gastroscopy was performed in 16 admissions and 1 was scheduled following discharge. Rat-tooth forceps were used in 31% and an overtube was used in 3 cases. The median time from presentation to gastroscopy was 673 minutes (IQR: 380-1013). Management was adherent to European Society of Gastrointestinal Endoscopy guidelines in 81%. After excluding admissions with FBI as a secondary diagnosis, median admission cost was $A1989 (IQR: $A643-$A4976) and total admission costs over the 3 years was $A84 448.
FBI in an Australian, non-prison referral centre is infrequent, can often be safely managed expectantly, and has limited impact on healthcare utilisation. Early, outpatient endoscopy could be considered for non-urgent cases, which may reduce costs while maintaining safety.
异物摄入（FBI）虽不常见，但可导致罕见的风险，包括穿孔。目前，人们对澳大利亚成年人 FBI 的影响知之甚少。我们旨在评估 FBI 患者的特征、结局和住院费用。
在澳大利亚墨尔本的一家非监狱转诊中心，对 FBI 患者进行了回顾性队列研究。国际疾病分类-10 编码在财政年度 2018-2021 期间确定了胃肠道 FBI 患者。排除标准为食物团块、药物异物、肛门或直肠内物体或非摄入。“紧急”分类标准为食管、大小>6cm、碟形电池、气道阻塞、腹膜炎、败血症和/或疑似内脏穿孔。
共有 26 例患者的 32 例住院被纳入研究。中位年龄为 36 岁（IQR：27-56），58%为男性，35%有既往精神或自闭症谱系障碍。无死亡、穿孔或手术。16 例住院患者行胃镜检查，1 例出院后计划行胃镜检查。31%使用鼠齿钳，3 例使用食管扩张器。从就诊到胃镜检查的中位时间为 673 分钟（IQR：380-1013）。81%的患者治疗符合欧洲胃肠道内镜学会指南。排除 FBI 作为次要诊断的住院患者后，中位住院费用为 1989 澳元（IQR：643-4976 澳元），3 年总住院费用为 84448 澳元。
在澳大利亚非监狱转诊中心，FBI 较为少见，通常可安全地期待治疗，对医疗保健利用的影响有限。对于非紧急病例，早期门诊内镜检查可能是可行的，这可以在保持安全性的同时降低成本。
