Foreign bodies in upper gastrointestinal tract and urgent endoscopic interventions - review of a ten-year period

Izhodišča. Tujki v zgornji prebavni cevi le redko povzročajo nujna stanja v gastroenterologiji. V prebavno cev zaidejo običajno ob hranjenju ali po pomoti. Nekatere skupine oseb, kaznjenci in psihiatrični bolniki, jih zaužijejo tudi namenoma. Avtorji so želeli ugotoviti delež bolnikov, pri katerih smo ob nujni endoskopski preiskavi ugotovili prave tujke v zgornji prebavni cevi, oceniti uspešnost endoskopskih posegov ter morebitne zaplete. Preiskovanci in metode. Raziskava zajema bolnike, pri katerih smo v desetletnem obdobju od 1. januarja 1994 do 31. decembra 2003 opravili nujne endoskopske preiskave zgornjih prebavil. Rezultati. Pregledali smo 6416 bolnikov, povprečne starosti 59,3 leta, SD +/- 17,2, v razponu od 1-106 let, 2452 žensk in 3964 moških. Pri 51 bolnikih, 0,8% vseh preiskovancev, smo ugotovili tujke v požiralniku ali želodcu. Skupaj smo opravili 65 endoskopskih posegov, v 94% smo tujke endoskopsko odstranili (48/51 bolnikov), pri treh pa endoskopski posegi niso bili uspešni. Med tujki smo odstranili najrazličnejše kovinske in plastične predmete: kovance, ključe, vijake, kljuke, baterije, britvice, igle, dele kuhinjskega, toaletnega ali pisalnega pribora, vžigalnike, gumbe, igrače, zobno ščetko, pa tudi zagozdene kosti. Pri bolnikih, ki so imeli uspešno endoskopsko odstranitev, nismo opazovali pomembnejših zapletov, le pri 3 bolnikih (3/48, 6,3%) smo opazovali blažje krvavitve iz predela ezofagogastrične stičnice. Zaključki. Tehnološki razvoj endoskopskih instrumentov je omogočil različne interventne posege. Metoda se je potrdila kot učinkovita pri odstranjevanju tujkov v zgornji prebavni cevi. Na uspeh posega vplivajo različni dejavniki, med pomembnejšimi so ustreznost opreme, izkušenost in potrpežljivost preiskovalca in endoskopske sestre ter seznanjenost in sodelovanje bolnika.Background. Foreign bodies in the upper digestive tube are rarely the cause of an urgent condition in gastroenterology. They usually enter the digestive tube during nutrition or by mistake. However, certain groups of the populationsuch as convicts or psychiatric patients tend to swallow them intentionally. The authors aim was to assess the percentage of patients in which urgent endoscopic investigation revealed true foreign bodies in the upper digestive tube, to evaluate the success of endoscopic preocedures and the resolution of eventual complications. Patients and methods. The study includes patients in which urgent endoscopic investigations of the upper digestive tract were performed in a 10-year period (1 January 1994 to 31 December 2003). Results. Altogether 6416 patients were investigated, mean age 59.3 years, SD +/- 17.2 years, range 1-106 years, 2452 females and 3964 males. In 51 patients, 0.8% of all subjects, foreign bodies were detected in the esophagus or stomach. In these patients a total of 65 endoscopic investigations were performed, in 94% the foreign bodies were removed endoscopically (48/51 patients), in three cases the endoscopic procedures were not successful. Among the foreign bodies removed were various metal or plastic objects: coins, keys, screws, hooks, batteries, razor blades, needles, parts of kitchen, toilet or writing utensils, lighters, buttons, toys, a toothbrush as well as impacted pieces of bone. In the patients with successful endoscopic removal of the objects, no significant complications were noted. In 3 patients (3/48, 6.3%) only mild hemorrhages from the region of the esophagogastric junction were observed. Conclusions. The technological development of endoscopic instruments made it possible to carry out different therapeutic procedures. The method has proved successful in removing foreign bodies from the upper digestive tube. Various factors affect the success of the procedure, the more important being adequate equipment, the experience and patience of the investigator and the assisting nurse, as well as the patient\u27s understanding of the procedure and his or her cooperation