Endoscopic removal of foreign bodies from gastrointestinal tract.

ABSTRACT

Forty-two children with ingestion of foreign bodies (FB) were managed conservatively. Thirty one (74%) of them were under 5 years of age. At presentation history revealed accidental ingestion in 95% and of being put in the oral cavity by elder sibs in 5% patients. Fifty seven per cent had respiratory distress, 38% had dysphagia and 12% had hematemesis. Foreign bodies were located in the gastrointestinal tract in the stomach (40%), esophagus (26%), small intestine (19%), duodenum (12%) and rectum (2%). A large majority of the FB were constituted by household objects. All the FB above the duodenojejunal junction and one in the rectum were retrieved successfully with fiberoptic endoscopes. In 19% patients, the FB had crossed duodenojejunal junction, and had come out in the stools during 4-5 days observation and these were mostly round in shape. Endoscopic procedures were carried out under intravenous diazepam or ketamine sedation. On endoscopic examination, 21% of them showed erosions in stomach and/or esophagus. No complications of endoscopic procedure or sedation were observed and none of the patients required surgical removal. Removal of FB with flexible fiberoptic endoscopes is less invasive and the best therapeutic option to avoid preventable complications of FB ingestion. In this procedure there is need of a trained and skilled Pediatric endoscopist with lot of patience and a good team work.