| Objective: To analyze the clinical characteristics of patients with esophageal foreign bodies(FBs)in our center,and to investigate risk factors associated with complications.Methods: We retrospectively collected the clinical data of patients with esophageal FBs treated in our center between January 2010 and December 2019,and analyzed the patients’ demographics,FBs’ characteristics and treatment.The injuries caused by FBs were graded according to the severity,and the patients were divided into three groups: no significant complications group,moderate complications group and severe complications group.Univariate and multivariate logistic regression analysis were performed to investigate independent risk factors for overall and severe complications.Results: A total of 2669 cases(male: 1160;female: 1509)of esophageal FBs were included.The median age was 53(IQR: 42-65)years,and the most common age range was 50-59 years.223 cases(8.4%)had underlying gastrointestinal diseases associated with esophageal FBs impaction,with mostly were anastomotic or other etiologies of stricture(210/223,94.2%).2600 patients(97.4%)had single presentation for FBs,while 28 patients had multiple presentations for a total of 69 cases(2.6%)among which 25 patients had anastomotic or other etiologies of stricture.Among 878 cases with specific information of FBs impaction duration,the cases with impaction duration ≤12 hours,12-24 hours,24-72 hours and >72 hours accounted for 44.5%,24.6%,10.1% and 20.7%,respectively.The common types of FBs included fish bones(1074,40.2%),animal bones(987,37.0%),food bolus(232,8.7%),jujube pits(217,8.1%),dental prostheses(53,2.0%).Cervical esophagus was the most common FBs impaction site(1446,54.2%),followed by upper thoracic esophagus(655,24.5%),mid thoracic esophagus(307,11.5%),lower esophagus(51,1.9%),and there were 210 cases(7.9%)impacted at the anastomotic or stricture site.The majority of FBs were managed with flexible endoscopy(2508,94.0%)and only a few cases were treated via rigid esophagoscopy(105,3.9%)or surgery(56,2.1%).In cases without anastomotic or other etiologies of stricture,incidence of grade Ⅰ,Ⅱ,Ⅲ and Ⅳ injury were 55.7%,24.8%,6.8% and 1.9%,respectively.The overall,moderate and severe complication rate were 33.5%,24.8% and 8.7%,respectively.Univariate and multivariate logistic regression analysis revealed that FB impaction duration longer than 12 hours was an independent risk factor for both of overall and severe complications,and the risk of complications increased with the longer impaction duration.Conclusions: 1.Esophageal FBs treated in our center are mainly composed of sharp foodborne FBs,and patients aged 50-59 years are most common.2.Cervical esophagus is the common site for FBs impaction,while FBs in the lower esophagus is rare.Anastomotic or other etiologies of stricture is the leading cause of food bolus impaction and multiple occurrences of FBs.3.Flexible endoscopy could manage most esophageal FBs,and rigid esophagoscopy could be considered an alternative for those failed via flexible endoscopy,especially located near the esophageal entrance.Failure of endoscopic management,migratory FBs completely penetrating the esophagus,and Grade Ⅳ injury are important surgical indications for esophageal FBs.4.Delayed presentation is common in patients with esophageal FBs,causing a long FBs impaction duration which is a major risk fact for associated injuries and complications.Hence,it is advocated that the time interval between FBs impaction and treatment should be shortened through multiple measures to reduce esophageal FBs induced injuries and complications.5.Aortic injury is the primary cause of death due to esophageal FBs,and attention should be paid to early identification,timely intervention and postoperative closely surveillance of high-risk patients. |
PDF Full Text Request