Western view of the management of gastroesophageal foreign bodies

Table 1 Classifications of foreign bodies

Objects shape

Short-blunt: Coins, rings

Long: Utensils for eating, string, cord, toothbrush

Sharp-pointed: Nails, pins, tacks, toothpicks, chicken, fish bones

Objects including poisons

Button cell and disk batteries

Cylindrical batteries (these batteries do not typically discharge electrical current the way button batteries do)

Narcotic packets

Objects inducing esophageal or gastrointestinal obstruction

Magnets

Food bolus impaction

Superabsorbent polymers

Table 2 Timing of endoscopy for ingested foreign bodies

Emergent endoscopy

Esophageal obstruction (patient unable to manage secretions)

Sharp-pointed objects in the esophagus (or in the stomach/small bowel if symptomatic)

Disk or button cell batteries in the esophagus (or in the stomach/small bowel if symptomatic)

Magnets in the esophagus (or in the stomach/small bowel if symptomatic)

Urgent endoscopy

Esophageal foreign objects that are not sharp-pointed

Esophageal food impaction in patients without complete obstruction

Sharp-pointed objects in the stomach or duodenum (if asymptomatic)

Objects > 6 cm in length at or above the proximal duodenum in adults

Disk and button cell batteries in the stomach (if age < 5 and button battery > 20 mm)

Magnets within endoscopic reach (if asymptomatic)

Absorptive object

Nonurgent (elective) endoscopy

Objects in the stomach with diameter 2.5 cm in adults

Objects > 2 cm and longer than 5 cm in older children

Objects longer than 3 cm in infants and young children

Coins in the esophagus may be observed for 12-24 h before endoscopic removal in an asymptomatic patient

Disk and button cell batteries and cylindrical batteries that are in the stomach of patients without signs of gastrointestinal injury may be observed for as long as 48 h. Batteries remaining in the stomach longer than 48 h should be removed

Modified from American Society of Gastrointestinal Endoscopy and NASPGHAN Endoscopy Committee.