Carlo Galdino Riva, Stefano Siboni, Davide Ferrari, Marco Sozzi, Alberto Aiolfi, Luigi Bonavina. IRCCS Policlinico San Donato
Introduction: Foreign body removal is a common emergency procedure. The main location of impaction is the upper esophagus. In non-complicated cases, flexible endoscopy is the treatment of choice. Rigid endoscopy is not mentioned in most guidelines, but it provides good exposure and safe extraction of larger size or sharp objects.
Methods: A systematic review of the literature was conducted, including all the articles that matched the words “Rigid endoscopy AND flexible endoscopy AND foreign body”. Heterogeneity was evaluated using I2index and Cochrane Qtest. Among 185 records screened, 7 studies were reviewed in full-text, of whom only 5 matched the inclusion criteria. Data collected from each work were: study characteristics, number of patients included in the series, localization of the foreign bodies, characteristics of the foreign bodies, endoscopic success rate, overall complication rate and perforation rate. Eventually, the results of the systematic review were summarized qualitatively into a frequentist meta-analysis.
Results: One thousand four hundred and two patients were included in the study. FE was performed in 736 patients and RE in 666. Overall, 101 (7.2%) complications occurred. The most frequent complications were mucosal erosion (26.7%), mucosal edema (18.8%), and iatrogenic esophageal perforations (10.9%). Compared to FE, the estimated RE pooled success OR was 1.00 (95% CI 0.48 – 2.06; p = 1.00). The pooled OR of iatrogenic perforation, other complications, and overall complications were 2.87 (95% CI 0.96 – 8.61; p = 0.06), 1.09 (95% CI 0.38 – 3.18; p = 0.87), and 1.50 (95% CI 0.53 – 4.25; p = 0.44), respectively. There was no mortality.
Conclusions: FE and RE are equally safe and effective for the removal of esophageal FB. To provide a tailored or crossover approach, patients should be managed in multidisciplinary centers where expertise in RE is also available. From a global health-care perspective, formal training and certification in RE should be reappraised.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95412
Program Number: P427
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster