Upper GI foreign body An adult urban emergency hospital experience W. C. Conway, C. Sugawa, H. Ono, C. E. Lucas Departments of Surgery, Detroit Receiving Hospital and Wayne State University, 6C–UHC, 4201 St. Antoine, Detroit, MI 48201, USA Received: 21 July 2006/Accepted: 10 August 2006/Online publication: 28 November 2006 Abstract Background: The efficacy of flexible endoscopy by a single endoscopist in the therapy of foreign body ingestion was assessed at an adult urban emergency hospital. Methods: Fifty-one adult patients with upper GI foreign body ingestion treated at Detroit Receiving Hospital from 1988 to 2004 were identified. Endoscopic and hospital medical records were reviewed to evaluate eti- ology, treatment, and outcomes for these patients. Results: The etiology was related to eating in 38(75%) patients, most of whom were eating meat; phytobezoars were seen in four, often after previous upper GI surgery. True foreign bodies were found in 13 patients (25%) and included a screwdriver, a ballpoint pen, spoons, coat hanger pieces, batteries, and latex gloves. Dysphagia was the most common symptom (75%); pain was com- mon in patients with true foreign bodies, and 62% of this group had psychiatric difficulties or problems with drug abuse. Nearly 80% of the food-related group had post- surgical or other upper GI pathology. One patient had an esophageal stricture secondary to previous Sengs- taken-Blakemore tube insertion. Flexible endoscopy was successful in extracting the foreign body in almost all (49) patients, with snare extraction the most common therapeutic modality. Both failures were of true foreign bodies that could not be safely removed. In one of these cases, it became necessary to employ the gallstone lith- otripter, and the overtube was required in patients with metallic or sharp foreign bodies to protect the upper aerodigestive structures. Conclusions: Most upper GI foreign bodies are related to food impaction, with meat most often found. Underlying pathology is the rule and should be dealt with immediately. Flexible endoscopy is the treatment of choice for upper GI foreign body removal with near perfect success. Key words: Gastrointestinal foreign body — Endo- scopic removal Foreign body ingestion occurs most commonly in chil- dren; coins are the most frequently ingested item [10, 11]. Although college students playing the popular game, ‘‘quarters,’’ may suffer a similar fate, most foreign body ingestions in adults are related to eating, leading to either bone or meat bolus impaction [6]. Poor dentition, inadequate chewing, and eating while sedated can pre- cipitate this problem. When meat impaction occurs, there is often underlying esophageal pathology [5, 9]. Several techniques have been devised for the treatment of foreign body ingestion, including rigid and flexible endoscopy, Foley catheter retraction, swallowing gas- forming agents, enzymatic digestion, and watchful waiting [1]. At present, many physicians recommend endoscopic techniques for both diagnosis and treatment. In the present study, the efficacy of flexible endoscopy in the management of foreign body ingestion by a single endoscopist was evaluated at Detroit Receiving Hospital (DRH). Methods A database of all patients treated from 1 January 1988 through 31 December 2004 by the surgical endoscopist at Detroit Receiving Hospital (DRH) was accessed. DRH is an urban adult emergency hospital, with more than 80,000 patient visits to the emergency room per year; it has a full-time dedicated surgical endoscopist. During the study period, the surgical endoscopist performed 12,817 esophago- gastroduodenoscopies (EGDs) on patients coming to the emergency room with upper gastrointestinal (GI) symptoms. This population included 7,783 men and 5,034 women, whose average age was 47.3 years (range:13–103 years). The primary indications for EGD in these This work was presented in the Poster Session at the 2006 SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) Annual Meeting, Dallas, Texas Correspondence to: C. Sugawa Surg Endosc (2007) 21: 455–460 DOI: 10.1007/s00464-006-9004-z Ó Springer Science+Business Media, Inc. 2006