Western view of the management of gastroesophageal foreign bodies

Abstract

The best modality for foreign body removal has been the subject of much controversy over the years. We have read with great interest the recent article by Souza Aguiar Municipal Hospital, Rio de Janeiro, Brazil, describing their experience with the management of esophageal foreign bodies in children. Non-endoscopic methods of removing foreign bodies (such as a Foley catheter guided or not by fluoroscopy) have been successfully used at this center. These methods could be an attractive option because of the following advantages: Shorter hospitalization time; easy to perform; no need for anesthesia; avoids esophagoscopy; and lower costs. However, the complications of these procedures can be severe and potentially fatal if not performed correctly, such as bronchoaspiration, perforation, and acute airway obstruction. In addition, it has some disadvantages, such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies. Therefore, in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

Keywords: Foreign bodies, Children, Foley catheter, Flexible endoscopy

Core tip: The best modality for foreign body removal has been the subject of much controversy over the years. Non-endoscopic methods such as a Foley catheter technique have a lot of advantages, such as their simplicity and cost savings, particularly for proximally located coins. However, their complications can be potentially serious regarding airway obstruction or perforation. This article will discuss the point of view of the European and Western countries, which usually recommend endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.