Risk Factors for Severe Complications in Patients with Esophageal Foreign Bodies / 대한내과학회지

ABSTRACT

BACKGROUND/AIMS: Complications by ingested foreign bodies are uncommon, since successful removal by endoscopy occurs in most cases. However, severe complications, such as perforation, can result in death. The aim of this study was to determine the risk factors associated with severe complications in patients with esophageal foreign bodies. METHODS: This study involved 298 patients who underwent successful removal of an esophageal foreign body between January 2001 and December 2014 at Dankook University Hospital. Medical records were reviewed retrospectively. Severe complications were defined as laceration, unstoppable bleeding with simple irrigation, or perforation. Risk factors for severe complications were analyzed using multivariate logistic regression. RESULTS: The most common foreign bodies in adults and pediatrics were fish bones (52.0%) and coins (61.0%). Complications included erosion, ulcer, laceration, bleeding, and perforation. Using multivariate analysis, the type (fish bone, odds ratio [OR] = 2.306, p = 0.004) and size (> 25 mm, OR = 2.614, p = 0.001) of the obstruction and duration of impaction (> 24 hours, OR = 1.887, p = 0.035) were risk factors for severe complications including laceration, bleeding, and perforation. For perforation, duration of impaction (> 24 hours, OR = 41.700, p = 0.005) was a statistically significant risk factor. In two patients, delayed perforation occurred despite successful endoscopic removal of the foreign body. CONCLUSIONS: Patients with esophageal fish bone foreign bodies, foreign bodies larger than 25 mm, and a duration of impaction longer than 24 hours should be treated carefully considering the possibility of severe complications. Specifically, patients with a duration of impaction longer than 24 hours should be closely observed due to increased risk of perforation and potential delayed perforation even after successful endoscopic removal.