Emergency Endoscopic Management of Upper Gastrointestinal Foreign Bodies During On-Call Hours

Abstract

Objective Foreign body impaction in the upper gastrointestinal tract is a common indication for emergency endoscopy and may lead to serious complications if not managed promptly. International guidelines recommend early endoscopic intervention; however, data regarding urgent procedures performed during on-call hours remain limited. To evaluate clinical characteristics and procedural outcomes in adult patients who underwent emergency upper gastrointestinal endoscopy for foreign body ingestion during on-call hours. Material and Method This retrospective observational study included adult patients who presented to the emergency department and underwent urgent upper gastrointestinal endoscopy between April 2021 and February 2024. Demographic variables, imaging modalities, time to endoscopy, sedation strategies, characteristics and locations of foreign bodies, spontaneous distal passage, and procedural success were analyzed. Multivariable logistic regression models were used to identify factors associated with spontaneous passage and endoscopic success. Results A total of 63 patients were included (mean age 43.3 ± 16.4 years; 52.4% male). Pre-procedural imaging was performed in 90.5% of cases, most commonly plain radiography. The mean time to endoscopy was 1.17 hours, and 95.2% of patients underwent the procedure within six hours of admission. Foreign bodies were detected endoscopically in 45 patients, whereas spontaneous distal passage occurred in 18 (28.5%). Sharp/pointed objects accounted for 60% of detected cases, and the esophagus was the most frequent location (55.6%). Endoscopic treatment was successful in 91.1% of patients, with only one patient requiring surgical intervention. The proportion of sharp/pointed objects was lower in the spontaneous-passage group, whereas pre-procedural imaging was significantly more frequent in these patients. Conclusion Emergency upper gastrointestinal endoscopy performed during on-call hours demonstrated high success rates and a low incidence of major complications. Early intervention within the first 6 hours was associated with favorable outcomes. The relatively high rate of spontaneous distal passage suggests that selected low-risk patients may benefit from imaging-guided evaluation and close clinical observation. These findings support guideline-based management strategies and provide a foundation for future multicenter prospective studies.

Keywords

• Emergency endoscopy
• Esophageal impaction
• Foreign body ingestion
• Upper gastrointestinal tract

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Ethical Statement

Ethical Approval Ethical approval was obtained from the Başakşehir Çam ve Sakura Clinical Research Ethics Committee (dated 24 April 2024; decision no. 264; reference number E-96317027-514.10-242629601). The study was conducted in accordance with the Declaration of Helsinki. Consent to Participate and Publish Informed consent was waived by the local ethics committee because of the retrospective nature of the study and the use of anonymized data.

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