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▶Ep 2 · 2:04
Some that get lodged high at the cricopharyngeus. If it's high in the esophagus, it's going to be where the aorta crosses over. That's not too common, and even less common is Rare vascular anomalies like subclavians, but more commonly if it's in the esophagus, typically it's at the lower esophageal sphincter where we end up going in and retrieving most foreign bodies.
if it is a, you know, one side of an object is sharp, and it's made it into the stomach, generally speaking, they actually make it through the through the GI tract without too much injury. Uh, you know, the sort of classic thought is that it flips and goes blunt side down
Digestive Foreign Bodies: Diagnosis and Management
▶Ep 2 · 2:04
quoteSome that get lodged high at the cricopharyngeus. If it's high in the esophagus, it's going to be where the aorta crosses over. That's not too common, and even less common is Rare vascular anomalies like subclavians, but more commonly if it's in the esophagus, typically it's at the lower esophageal sphincter where we end up going in and retrieving most foreign bodies.↗
▶Ep 2 · 2:04
clinicalEsophageal foreign bodies commonly lodge at three sites: high at the cricopharyngeus, where the aorta crosses over (less common), and most commonly at the lower esophageal sphincter.↗
▶Ep 2 · 3:29
epidemiologicalThe most common age group for foreign body ingestion is 6 months to 6 years (just mobile infants through toddler age range).↗
▶Ep 2 · 3:29
clinicalForeign body ingestion can occur in very young infants, such as when a toddler tries to feed an infant.↗
▶Ep 2 · 3:29
quoteThe most common age group is probably the just mobile. Infants through toddler age range, so maybe like 6 months to 6 years.↗
▶Ep 2 · 5:04
quoteThere's a fair number of patients who never make it to us, you know, that they call the pediatrician. The pediatrician appropriately realizes that it's a small object that is likely to pass↗
▶Ep 2 · 5:04
clinicalMany patients with small objects that are likely to pass never reach gastroenterology, as pediatricians appropriately manage them expectantly in asymptomatic children.↗
▶Ep 2 · 5:42
clinicalSymptoms of esophageal foreign bodies include odynophagia (pain with swallowing), intolerance of secretions and drooling, pointing to one spot on the throat (especially in younger children), vomiting after attempting to swallow, chest pain, and refusal to eat in chronic cases.↗
clinicalPhysical examination findings are usually minimal in patients with digestive foreign bodies.↗
▶Ep 2 · 7:17
clinicalCross-sectional imaging is very rarely considered for foreign body workup.↗
▶Ep 2 · 7:17
clinicalFor asymptomatic patients with strong suspicion of radiolucent foreign body ingestion not visible on plain X-ray, a contrast study may be performed.↗
▶Ep 2 · 7:17
clinicalContrast studies should not be performed if suspicion is high and the patient is symptomatic, and contrast can make endoscopic retrieval more difficult.↗
▶Ep 2 · 7:17
clinicalThe classic teaching that coins in the esophagus appear coronal and coins in the airway appear sagittal is not always the case according to published evidence.↗
▶Ep 2 · 7:17
guidelineInitial imaging for suspected foreign body ingestion is a two-view abdomen and chest X-ray.↗
▶Ep 2 · 7:17
quoteUm, and we would generally start with uh a two view abdomen and chest X-ray.↗
▶Ep 2 · 7:17
quoteif you remember the classic teaching of coins in the esophagus, you're going to see in coronal and then coins in the airway, you're going to see sagittal, well, there's good published evidence that says that that's not always the case↗
▶Ep 2 · 8:20
clinicalEosinophilic esophagitis should be suspected with family history of the condition or frequent food impactions, strong atopic history (food allergy, asthma, severe eczema, rhinitis), or when an object that should have passed becomes lodged in the esophagus.↗
▶Ep 2 · 9:19
clinicalThe double-edged sign (a step-off especially visible on lateral X-ray) is classic for button batteries, though it may not always be visible depending on how long the battery has been present.↗
▶Ep 2 · 9:19
quoteif there is a strong concern, especially if it was a witness, uh, esophageal button battery, um, we treat those as emergencies and take them, you know, within 2 hours to the operating room for removal.↗
▶Ep 2 · 9:19
guidelineWitnessed esophageal button batteries are treated as emergencies and taken to the operating room for removal within 2 hours.↗
▶Ep 2 · 9:19
quotebutton batteries uh change our change our evaluation, um, pathway considerably. You know, that's, that's, that's probably the biggest and most common need for emergent removal.↗
▶Ep 2 · 9:19
clinicalButton batteries are the biggest and most common need for emergent foreign body removal.↗
▶Ep 2 · 10:44
clinicalWhen concerned about a button battery, imaging should include the whole neck and chest to rule out a more proximal battery that may have been cut off the film.↗
▶Ep 2 · 11:09
opinionGuidance exists to let asymptomatic patients with gastric button batteries go home, but many practitioners are uncomfortable with this due to fatal gastric button battery ingestions and will retrieve them immediately if reachable.↗
▶Ep 2 · 11:09
quoteThe guidance is, is that you can, if a patient is asymptomatic, you can sometimes let them go. I think many of us don't feel comfortable with that, um, and I think unfortunately here we've had several of us have had fatal gastric button battery ingestion.↗
▶Ep 2 · 12:09
clinicalEsophageal foreign bodies are generally retrieved, though there may be an argument for expectant management in bigger asymptomatic kids.↗
▶Ep 2 · 12:09
guidelineGuidance indicates that esophageal foreign bodies present for 24 hours can cause significant problems.↗
▶Ep 2 · 12:09
quoteIf it's lodged in the esophagus, we would tend to go get it.↗
▶Ep 2 · 12:09
quoteI think that the guidance is still, if it's, if it's in the esophagus for, you know, 24 hours, um, it can cause big problems.↗
▶Ep 2 · 12:45
clinicalFor esophageal foreign bodies present for a short time in asymptomatic patients, the patient may be admitted and a repeat X-ray obtained in the morning; if the object has not moved, it should be retrieved.↗
▶Ep 2 · 12:45
quoteif it's been a short period of time and they're asymptomatic, we will admit them. You know this is typically the, do you do this in the middle of the night question. Um, we will frequently admit them and then repeat a film in the morning. If it's not moved, then we're going to go get it.↗
▶Ep 2 · 13:21
clinicalRelatively large foreign bodies (4 or 5 centimeters) in the stomach may not pass the pylorus and have a higher likelihood of requiring retrieval.↗
▶Ep 2 · 13:21
clinicalRound gastric foreign bodies unlikely to cause injury in asymptomatic children are typically allowed to pass and looked for in the stool.↗
▶Ep 2 · 13:21
quoteRelatively large foreign bodies, you know, 4 or 5 centimeters. They may not make it past the pylorus, so we'd probably have a higher likelihood of going to try to get it.↗
▶Ep 2 · 13:52
clinicalDouble-headed sharp objects like toothpicks are retrieved if at all possible.↗
▶Ep 2 · 13:52
quoteDouble-headed things, so toothpicks, we, we tend to go and try to get, if at all humanly possible.↗
▶Ep 2 · 13:52
clinicalOpen safety pins are retrieved if reachable.↗
▶Ep 2 · 13:52
quoteif it is a, you know, one side of an object is sharp, and it's made it into the stomach, generally speaking, they actually make it through the through the GI tract without too much injury. Uh, you know, the sort of classic thought is that it flips and goes blunt side down↗
▶Ep 2 · 13:52
clinicalObjects like nails or pins in the stomach are retrieved if reachable, but significant effort is not expended once they pass beyond the stomach; patients are watched for symptoms.↗
▶Ep 2 · 13:52
clinicalSharp objects with one sharp side that reach the stomach generally pass through the GI tract without significant injury, with the theory that they flip and go blunt side down.↗
▶Ep 2 · 15:32
clinicalGastroenterology typically uses flexible scopes for all foreign body retrievals.↗
▶Ep 2 · 15:32
quotefor, for GI we will go after everything with a flexible scope.↗
▶Ep 2 · 15:32
quoteproximal, very proximal, um, Esophageal foreign bodies are very difficult to get with a flexible scope. Um, and so having either surgery or ENT, um, go after it with a rigid scope is almost certainly preferable.↗
▶Ep 2 · 15:32
clinicalVery proximal esophageal foreign bodies are very difficult to retrieve with a flexible scope and are preferably removed by surgery or ENT with a rigid scope.↗
