1 Hospital Dona Estefânia, Lisboa, Portugal
Objectives and Study: Background – Esophageal foreign body and food bolus impaction (EFBFBI) are a common problem in children and adolescents requiring urgent evaluation and treatment, and may be the first sign of underlying esophageal pathology. Objective –To determine if there were any changes, over a 30-year period in 10-year frames, especially in respect to the nature of the foreign body (FB) ingested and esophageal pathology.
Methods: Design – Retrospective study. Setting – Tertiary care center. Cases of EFBFBI were identified by querying endoscopic reports from October 1984 to September 2014 for “foreign body” or “food impaction” in the esophagus. The variables examined were age, sex, FB type, FB location, presence of esophageal disease and esophageal pathology. Histological findings of esophageal biopsies were reviewed.
Results: During the period in study a total of 249 patients presented EFBFBI (81, 82 and 86 in each 10-year frame). Male/Female ratio and the mean age ± standard deviation (SD) were 1.11:1.0, and 4.8 ± 4.3 years, respectively. Endoscopic localization of the objects showed: 155 - proximal, 40 - middle and 54 - in the distal esophagus. Considering FB nature, 191(76.7%) were inorganic and 58 (23.3%) were organic, being coins (54.6%) and meat (13.3%) the main cause of impaction in each group. The esophageal mucosa showed non-specific changes in 203 (85.3%) patients. An underlying stricture was found in 33 (13.3%) children associated with esophageal atresia (16), peptic esophagitis (11) and caustic esophagitis (6). Eosinophilic esophagitis (EoE) and reflux esophagitis features was found in 9 and 4 patients, respectively. There were no significant differences in the number and type of FB over each 10-year period, exception for a slight decrease in the number of coins impaction and an increase in the number of button batteries (BB) and food meat bolus impaction in the last 10-years period. There were 33 meat bolus impaction, 15 in the first 20-year period and 18 in the last 10-year period, being 5 associated with esophageal stricture, 9 with EoE, 3 with reflux esophagitis and 1 with normal mucosa. There was esophageal damage in all 9 BB impactions with one esophageal stenosis as a delayed complication. All the diagnosis of EoE were made in the last 8 years. Esophageal biopsies were only performed in 12 patients with meat bolus impaction. Conclusion: Inorganic FB ingestions remained stable over the last 30 years, but the number of BB ingestions increased with potentially fatal clinical implications. Public awareness is essential in preventing complications. The number of meat bolus impaction has increased with the increasing prevalence of EoE. Esophageal mucosal biopsy should be considered for all children with middle and distal EFBFBI not attributed to stricture, particularly those with meat bolus impaction.
Disclosure of Interest: None Declared
JPGN, Vol. 60, Supplement 1, 336-7, May 2015
Poster (PO-G-0084, Gastroenterology, Endoscopy)
48th Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), Amsterdam, 6-9 May, 2015