Foreign bodies in the gastrointestinal tract in children: algorithm of management and choice of instruments for endoscopic removal

Abstract

BACKGROUND: A foreign body (FB) in the gastrointestinal tract (GIT) may require either emergent removal or careful observation till its natural coming out. The effectiveness of endoscopic procedure (EP) in pediatrics depends on adequate medical knowledge and medical equipment. Not uncommon, endoscopists and surgeons from adult medical centers remove FB in children. Over the past decades, EP in the GIT has become the safest and most successful technique for FB diagnosis and removal.

Up to now, there is no algorithm for managing and removing FB in children, or it does not always meet needs in clinical practice. To assess and choose the most optimal endoscopic equipment and instrumental accessories regarding child’s age, FB type and its harmful effects is still an important issue.

AIM: To improve a management algorithm and selection of optimal equipment to ensure timely diagnostics and successful endoscopic removal of FBs from GIT in children.

METHODS: A retrospective three-center analysis of children’s medical histories with suspected FBs in GIT from 2017 to 2020. The following parameters were analysed: clinical, X-ray and endoscopic diagnostic techniques depending on patient's age, FB location, its type and radiopacity, time before its removal, as well as type and effectiveness of endoscopic instrument, duration of endoscopic procedure, its effectiveness and complications, if any.

RESULTS: 1173 children were taken in the study (boys n=676, girls n=497,) average age 3.5±3.3, (0–17 y.o.). FB diagnosis was confirmed in 1008 (100%) patients; endoscopy was performed in 756 (75%) cases; endoscopic removal — in 751 out of 756 cases. Surgeries were made to three children with giant trichobezoars and to two children with magnet objects which were complicated by perforation in one case and by intestinal obstruction in the other one. The performed retrospective analysis of children’s medical histories with suspected GIT FBs allowed to modify the algorithm of multidisciplinary approach to the management and endoscopic removal of swallowed objects. Examination by an ENT specialist and a pediatric surgeon was mandatory at the reception department. The pediatric surgeon formulated indications for X-ray examination in two projections. The confirmed fact of FB swallowing and X-ray findings could be indicators for CT scanning. After FB presence has been confirmed, the patient is jointly consulted by a pediatric surgeon, anesthesiologist and endoscopist so as to determine indications and time interval for removing a swallowed object endoscopically.

Endoscopic instruments — net, rat tooth, forceps, loop and basket — turned out to be the most universal ones for removing four FB types, with the best average time of the procedure.

There were no complications related to FB endoscopic removal.

CONCLUSION: The proposed algorithm modification in child’s management and removal of GIT FB, the optimal choice of endoscopic equipment and manipulation accessories depending on patient’s age, FB location, type and its harm are key points to its successful and effective FB removal in children.

Keywords

endoscopy / children / foreign bodies / algorithm

References

[1] Shavrov АА (Jr.), Morozov DA, Shavrov AA, et al. Emergency gastrointestinal endoscopy in children. Clin Pract Pediatr. 2019;14(5):58–65. EDN: TJDGOE doi: 10.20953/1817-7646-2019-5-58-65

[2] Шавров А.А. (мл.), Морозов Д.А., Шавров А.А., и др. Неотложная гастроинтестинальная эндоскопия у детей // Вопросы практической педиатрии. 2019. Т. 14, № 5. С. 58–65. EDN: TJDGOE doi: 10.20953/1817-7646-2019-5-58-65

[3] Panfilova VN, Korolev MP, Shavrov AA, et al. Pediatric endoscopy. Methodological recommendations. Saint Petersburg; 2020. 112 р. (In Russ.)

[4] Панфилова В.Н., Королев М.П., Шавров А.А., и др. Детская эндоскопия. Методические рекомендации. Санкт-Петербург, 2020. 112 с.

[5] Shavrov AA (Jr.), Kharitonova AYu, Shavrov AA, Morozov DA. Modern methods of endoscopic diagnostics and treatment for upper gastrointestinal tract diseases in pediatrics. Curr Pediatr. 2015;14(4):497–502. EDN: UIKOSJ doi: 10.15690/vsp.v14.i4.1389

[6] Шавров А.А. (мл.), Харитонова А.Ю., Шавров А.А., Морозов Д.А. Современные методы эндоскопической диагностики и лечения болезней верхнего отдела пищеварительного тракта у детей // Вопросы современной педиатрии. 2015. Т. 14, № 4. С. 497–502. EDN: UIKOSJ doi: 10.15690/vsp.v14.i4.1389

[7] Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: A clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60(4):562–574. doi: 10.1097/MPG.0000000000000729

[8] Kramer R.E., Lerner D.G., Lin T., et al. Management of ingested foreign bodies in children: A clinical report of the NASPGHAN Endoscopy Committee // J Pediatr Gastroenterol Nutr. 2015. Vol. 60, N 4. P. 562–574. doi: 10.1097/MPG.0000000000000729

[9] Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: Presentation, complications, and management. Int J Pediatr Otorhinolaryngol. 2013;77(3):311–317. doi: 10.1016/j.ijporl.2012.11.025

[10] Jayachandra S., Eslick G.D. A systematic review of paediatric foreign body ingestion: Presentation, complications, and management // Int J Pediatr Otorhinolaryngol. 2013. Vol. 77, N 3. P. 311–317. doi: 10.1016/j.ijporl.2012.11.025

[11] Donskoy DV, Ionov DV, Korovin SA, et al. Classification and treatment of foreign bodies in the gastrointestinal tract. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2017;21(3):127–130. EDN: YTBDRZ doi: 10.18821/1560-9510-2017-21-3-127-130

[12] Донской Д.В., Ионов Д.В., Коровин С.А., и др. Классификация и лечебная тактика при инородных телах желудочно-кишечного тракта у детей // Детская хирургия. 2017. Т. 21, № 3. С. 127–130. EDN: YTBDRZ doi: 10.18821/1560-9510-2017-21-3-127-130

[13] Sugawa C, Ono H, Taleb M, Lucas CE. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A review. World J Gastrointest Endosc. 2014;6(10):475–481. doi: 10.4253/wjge.v6.i10.475

[14] Sugawa C., Ono H., Taleb M., Lucas C.E. Endoscopic management of foreign bodies in the upper gastrointestinal tract: A review // World J Gastrointest Endosc. 2014. Vol. 6, N 10. P. 475–481. doi: 10.4253/wjge.v6.i10.475

[15] Tsai J, Shaul DB, Sydorak RM, et al. Ingestion of magnetic toys: Report of serious complications requiring surgical intervention and a proposed management algorithm. Perm J. 2013;17(1):11–14. doi: 10.7812/TPP/12-097

[16] Tsai J., Shaul D.B., Sydorak R.M. Ingestion of magnetic toys: Report of serious complications requiring surgical intervention and a proposed management algorithm // Perm J. 2013. Vol. 17, N 1. P. 11–14. doi: 10.7812/TPP/12-097

[17] Ergun E, Ates U, Gollu G, et al. An algorithm for retrieval tools in foreign body ingestion and food impaction in children. Dis Esophagus. 2021;34(1):doaa051. doi: 10.1093/dote/doaa051

[18] Ergun E., Ates U., Gollu G., et al. An algorithm for retrieval tools in foreign body ingestion and food impaction in children // Dis Esophagus. 2021. Vol. 34, N 1. P. doaa051. doi: 10.1093/dote/doaa051

[19] Liao AY, McDonald D. Oesophageal complication from button battery ingestion in an infant. J Paediatr Child Health. 2013;49(4):330–332. doi: 10.1111/j.1440-1754.2012.02511.x

[20] Liao A.Y., McDonald D. Oesophageal complication from button battery ingestion in an infant // J Paediatr Child Health. 2013. Vol. 49, N 4. P. 330–332. doi: 10.1111/j.1440-1754.2012.02511.x

[21] Chessman R, Verkerk M, Hewitt R, Eze N. Delayed presentation of button battery ingestion: A devastating complication. BMJ Case Rep. 2017;2017:bcr2017219331. doi: 10.1136/bcr-2017-219331

[22] Chessman R., Verkerk M., Hewitt R., Eze N. Delayed presentation of button battery ingestion: A devastating complication // BMJ Case Rep 2017. Vol. 2017. P. bcr2017219331. doi: 10.1136/bcr-2017-219331

[23] Braumann C, Goette O, Menenakos C, et al. Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient. Surg Endosc. 2004;18(5):870. doi: 10.1007/s00464-003-4266-1

[24] Braumann C., Goette O., Menenakos C., et al Laparoscopic removal of ingested pin penetrating the gastric wall in an immunosuppressed patient // Surg Endosc. 2004. Vol. 18, N 5. P. 870. doi: 10.1007/s00464-003-4266-1

[25] Mehran A, Podkameni D, Rosenthal R, et al. Gastric perforation secondary to ingestion of a sharp foreign body. JSLS. 2005;9(1):91–93.

[26] Mehran A., Podkameni D., Rosenthal R., et al Gastric perforation secondary to ingestion of a sharp foreign body // JSLS. 2005. Vol. 9, N 1. P. 91–93.

[27] Goh BK, Chow PK, Quah HM, et al. Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies. World J Surg. 2006;30(3):372–377. EDN: MGTMUA doi: 10.1007/s00268-005-0490-2

[28] Goh B.K., Chow P.K., Quah H.M., et al Perforation of the gastrointestinal tract secondary to ingestion of foreign bodies // World J Surg. 2006. Vol. 30, N 3. P. 372–377. EDN: MGTMUA doi: 10.1007/s00268-005-0490-2

[29] Akcam M, Kockar C, Tola HT, et al. Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum. Gastrointest Endosc. 2009;69(2):382–384. doi: 10.1016/j.gie.2008.03.1084

[30] Akcam M., Kockar C., Tola H.T., et al Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum // Gastrointest Endosc. 2009. Vol. 69, N 2. P. 382–384. doi: 10.1016/j.gie.2008.03.1084

[31] Garcia-Segui A, Bercowsky E, Gomez-Fernandez I, et al. Late migration of a toothpick into the bladder: Initial presentation with urosepsis and hydronephrosis. Arch Esp Urol. 2012;65(6):626–629.

[32] Garcia-Segui A., Bercowsky E., Gomez-Fernandez I., et al. Late migration of a toothpick into the bladder: Initial presentation with urosepsis and hydronephrosis // Arch Esp Urol. 2012. Vol. 65, N 6. P. 626–629.

[33] Karadayi SS, Nadir A, Kaptanoglu M. Wandering pins: Case report. Cumhuriyet Med J. 2009;31(3):300–302.

[34] Karadayi S.S., Nadir A., Kaptanoglu M. Wandering pins: Case report // Cumhuriyet Med J. 2009. Vol. 31, N 3. P. 300–302.

[35] Sai Prasad TR, Low Y, Tan CE, et al. Swallowed foreign bodies in children: Report of four unusual cases. Ann Acad Med Singapore. 2006;35(1):49–53.

[36] Sai Prasad T.R., Low Y., Tan C.E., et al. Swallowed foreign bodies in children: Report of four unusual cases // Ann Acad Med Singapore. 2006. Vol. 35, N 1. P. 49–53.

[37] Mehmetoğlu F. A retrospective 10-year analysis of water absorbent bead ingestion in children. Hindawi Emergency Med Int. 2018;2018:5910527. doi: 10.1155/2018/5910527

[38] Mehmetoğlu F. A retrospective 10-year analysis of water absorbent bead ingestion in children // Hindawi Emergency Med Int. 2018. Vol. 2018. P. 5910527. doi: 10.1155/2018/5910527

[39] Cairns R, Brown JA, Buckley NA. Dangerous toys: The expanding problem of water-absorbing beads. Med J Australia. 2016;205(11):528. doi: 10.5694/mja16.00936

[40] Cairns R., Brown J.A., Buckley N.A. Dangerous toys: The expanding problem of water-absorbing beads // Med J Australia. 2016. Vol. 205, N 11. P. 528. doi: 10.5694/mja16.00936

[41] Moon JS, Bliss D, Hunter CJ. An unusual case of small bowel obstruction in a child caused by ingestion of water-storing gel beads. J Pediatric Surg. 2012;47(9):E19–E22. doi: 10.1016/j.jpedsurg.2012.04.005

[42] Moon J.S., Bliss D., Hunter C.J. An unusual case of small bowel obstruction in a child caused by ingestion of water-storing gel beads // J Pediatric Surg. 2012. Vol. 47, N 9. P. E19–E22. doi: 10.1016/j.jpedsurg.2012.04.005

[43] Zamora J, Vu LT, Larimer EL, Olutoye OO. Water-absorbing balls: A growing problem. Pediatrics. 2012;130(4):e1011–e1014. doi: 10.1542/peds.2011-3685

[44] Zamora J., Vu L.T., Larimer E.L., Olutoye O.O. Water-absorbing balls: A growing problem // Pediatrics. 2012. Vol. 130, N 4. P. e1011–e1014. doi: 10.1542/peds.2011-3685

[45] Muthukumaran J, Vivek S. Intestinal obstruction due to accidental ingestion of hygroscopic foreign body. Indian Pediatrics. 2014;51(12):1022–1102.

[46] Muthukumaran J., Vivek S. Intestinal obstruction due to accidental ingestion of hygroscopic foreign body // Indian Pediatrics. 2014. Vol. 51, N 12. P. 1022–1102.

[47] Mirza B, Sheikh A. Mortality in a case of crystal gel ball ingestion: An alert for parents. APSP J Case Rep. 2012;3(1):6.

[48] Mirza B., Sheikh A. Mortality in a case of crystal gel ball ingestion: An alert for parents // APSP J Case Rep. 2012. Vol. 3, N 1. P. 6.

[49] Ooi M, Young EJ, Nguyen NQ. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus. Gastrointest Endosc. 2018;87(5):1198–1203. doi: 10.1016/j.gie.2017.12.022

[50] Ooi M., Young E.J., Nguyen N.Q. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus // Gastrointest Endosc. 2018. Vol. 87, N 5. P. 1198–1203. doi: 10.1016/j.gie.2017.12.022

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Shavrov A.A., Merkulova A.O., Shavrov A.A., Morozov D.A., Kharitonova A.Y., Ibragimov S.I., Frolov E.A.