| ObjectiveTo investigate the clinical features of foreign body impaction in the esophagus,as well as to analyze the related factors for successful removal by endoscopy and the clinical complications.MethodsBetween October 2015 and August 2016,we enrolled 595 patients with clinical suspicion of foreign body impaction from 18 general hospitals in 10 cities in Zhejiang Province.Using uniform questionnaires,we collected demographic data of the patients,including age and gender;the clinical features,including past related diseases,symptoms and radiographic imaging;and data about endoscopic management,including types,lengths and locations of foreign bodies,endoscopic treatment,retrieval devices.Consequently,we summarized the related clinical complications and analyzed the attributing factors for their occurrence.Furthermore,we analyzed the associated factors for successful removal by endoscopy.Results(1)The study enrolled 595 cases suspected with foreign body impaction,with the mean age of 51.7±20.1 years old.There were 278 men and 317 women.(2)The most common types of foreign bodies were fish bones(34.0%),chicken bones(22.1%),fruit nucleus(17.1%)and food bolus(14.6%).The majority of them were short objects(<2.5cm,74.0%),followed by middle objects(2.5?6.0cm,24.5%)and long objects(>6cm,1.5%).Most objects were lodged in the proximal esophagus(75.9%),followed by the middle segment(15.2%)and the distal segment(8.9%)of esophagus.(3)96.3%of all cases had obvious clinical symptoms.Symptoms were more often observed in the proximal segment of the esophagus(98.1%)than in the distal segment(92.6%)(p<0.001).However,they were not correlated with the patients'ages or gender,types of foreign bodies(p>0.05).(4)The removal rate of endoscopy was 94.5%.It was even higher with prior anesthesia(99.3%)than non-sedation(92.7%)(p<0.01).However,it was not correlated with the retention time,locations,types and lengths of the impacted foreign bodies(p>0.05).(5)Complication rate was as high as 34.0%,which was increased with long retention time and sharp objects(p<0.001).The rate was increased by 2.2-and 6.2-folds after impacted for longer than 24 hours and 48 hours as compared to shorter than 12 hours.Logistic regression analysis indicated that sharp objects had obviously increased complications than non-sharp ones(OR=3.369 95%CI:1.97-5.74,p<0.001).However,complications were unrelated with the locations or lengths of foreign bodies(p>0.05).Particularly,the rate of perforation was 5.6%,which was strongly related with long retention time and sharp objects(p<0.01),but not with locations or lengths of the objects(p>0.05).The risk increased dramatically by 13.4-and 31.1-folds with the lodging time longer than 24 hours and 72 hours as compared to less than 12 hours(p<0.01).Conclusions(1)Endoscopy is an efficient and safe approach with high removal rate.(2)Assisted anesthesia could significantly increase the removal rate under endoscopy.(3)Foreign bodies,especially the sharp ones,should be removed as soon as possible within 24 hours,to further decrease severe complications. |
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