Üst gastrointestinal sistem yabancı cisimleri ve gıda takılmalarında endoskopi deneyimimiz

Yıl 2020, Cilt: 28 Sayı: Sayı: 3, 95 - 100, 30.12.2020

Tolga Düzenli , Hüseyin Köseoğlu

https://doi.org/10.17940/endoskopi.845879

Öz

Giriş ve Amaç: Yabancı cisimlerin yutulmasına bağlı başvurular, gastroenterolojik aciller arasında önemli bir yer tutmaktadır. Bu çalışmadaki amacımız; üst gastrointestinal sistemde yabancı cisim veya gıda takılması nedeniyle endoskopi yapılan hastalarımızı araştırmak ve klinik tecrübelerimizi paylaşmaktır. Gereç ve Yöntem: Hitit Üniversitesi Hastanesi acil servisine Mart 2017-Mart 2020 tarihleri arasında yabancı cisimlerin yutulmasına bağlı başvurarak endoskopi yapılan olgular çalışmaya dahil edildi. Bulgular: Çalışmaya toplam 31 hasta (13 kadın, 18 erkek) dahil edildi. Endoskopik tedavi başarı oranı %96.8 (n=30/31) idi. Hastaların acil servise müracaatındaki şikayetleri yabancı cismi hissetme %87.1 disfaji %74.2, odinofaji %22.6 iken %12.9 hasta asemptomatik idi. Yabancı cismin özelliği olarak hastaların %58.1 inde künt/yumuşak cisimler ve gıda impaksiyonu izlenirken; %41.9 hastada sivri/kesici/delici cisim mevcuttu. Yerleşim yeri hastaların %83.9’unda özofagus; %12.9’unda mide; %3.2’sinde duodenum idi. Acil servise başvurularında median zaman (acile giriş kayıt saati) 14:47 idi. Acile ilk başvurudan endoskopiye kadar geçen süre 1-24 saat arası, median süre ise 3 saat idi. Endoskopik tedavi yöntemleri olarak; biyopsi forsepsi, fare dişli/timsah dişli grasperlar, snare, fileli snare, overtüp ya da endoskop yardımıyla mideye ilerletme yöntemleri kullanıldı. Sonuç: Üst gastrointestinal sistem yabancı cisimlerinde endoskopik tedavi yöntemleri etkili ve güvenlidir. Endoskopik tedavide seçilecek yöntemler; yabancı cismin tipi, yabancı cismin yeri, eşlik eden diğer faktörlere ve hastanın özelliklerine göre bireyselleştirilmelidir.

Anahtar Kelimeler

Yabancı cisim, endoskopi, gıda takılması, üst gastrointestinal sistem

Endoscopic management of foreign bodies and food impactions in the upper gastrointestinal tract

Öz

Background and aims: Foreign object ingestion and food bolus impaction have an important place among gastroenterological emergencies. Herein, clinical experiences of patients with foreign body ingestion in a tertiary referral center is reported. Materials and methods: Included in this study are patients at the Hitit University Hospital who underwent endoscopy with ingestion of foreign bodies or food impactions between March 2017 and 2020. Results: A total of 31 patients (13 females and 18 males) were enrolled. Success rate for endoscopic treatment was 96.8% (n=30/31). Patients presented feeling of foreign body 87.1%, dysphagia 74.2%, odynophagia 22.6%, whereas 12.9% were asymptomatic. Of the patients, 58.1% was observed to have blunt/soft foreign bodies and food impaction and 41.9% having sharp/cutting/piercing objects. Foreign bodies were found in the esophagus (83.9%), stomach (12.9%), and duodenum (3.2%). The median time for emergency service check-in was at 14:47. The time interval between emergency services to endoscopy (door-to-scope) was 1–24 hr (median of 3 hr). Endoscopic treatment methods were retrieval forceps, rat/alligator-tooth forceps, polypectomy snare, retrieval baskets, overtube, and pushing to the gastric cavity. Conclusions: For retrieval of foreign bodies, endoscopic treatment methods were safe and effective. Endoscopic methods should be individualized according to the foreign body’s type and location and the patient’s clinical characteristics.

Anahtar Kelimeler

Foreign body, endoscopy, food impaction, upper gastrointestinal tract

Kaynakça

• 1. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011;73:1085-91.
• 2. Lee CY, Kao BZ, Wu CS, et al. Retrospective analysis of endoscopic management of foreign bodies in the upper gastrointestinal tract of adults. J Chin Med Assoc 2019;82:105-9.
• 3. 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;6:475-81.
• 4. Geraci G, Sciume C, Di Carlo G, Picciurro A, Modica G. Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults. BMC Emerg Med 2016;16:42.
• 5. Aiolfi A, Ferrari D, Riva CG, et al. Esophageal foreign bodies in adults: systematic review of the literature. Scand J Gastroenterol 2018;53:1171-8.
• 6. Gretarsdottir HM, Jonasson JG, Bjornsson ES. Etiology and management of esophageal food impaction: a population based study. Scand J Gastroenterol 2015;50:513-8.
• 7. Long B, Koyfman A, Gottlieb M. Esophageal foreign bodies and obstruction in the emergency department setting: An Evidence-Based Review. J Emerg Med 2019;56:499-511.
• 8. Emara MH, Darwiesh EM, Refaey MM, Galal SM. Endoscopic removal of foreign bodies from the upper gastrointestinal tract: 5-year experience. Clin Exp Gastroenterol 2014;7:249-53.
• 9. Limpias Kamiya KJ, Hosoe N, Takabayashi K, et al. Endoscopic removal of foreign bodies: A retrospective study in Japan. World J Gastrointest Endosc 2020;12:33-41.
• 10. Sperry SL, Crockett SD, Miller CB, Shaheen NJ, Dellon ES. Esophageal foreign body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis. Gastrointest Endosc 2011;74:985-91.
• 11. Tseng HJ, Hanna TN, ShuaibW, et al. Imaging foreign bodies: ingested, aspirated, and inserted. Ann Emerg Med 2015;66:570-82.
• 12. Larsson H, Bergquist H, Bove M. The incidence of esophageal bolus impaction: is there a seasonal variation? Otolaryngol Head Neck Surg 2010;144:186-90.
• 13. Shuja A, Winston DM, Rahman AU, et al. Esophageal food impaction during cultural holidays and national athletic events. Gastroenterol Rep 2017;5:43-6.
• 14. Birk M, Bauerfeind P, Deprez PH, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48:489-96.
• 15. Krill T, Samuel R, Vela A, et al. Outcomes of delayed endoscopic management for esophageal soft food impactions. Gastrointest Endosc 2020;91:806-12.
• 16. Melendez-Rosado J, Corral JE, Patel S, Badillo RJ, Francis D. Esophageal food impaction: Causes, elective intubation, and associated adverse events. J Clin Gastroenterol 2019;53:179-83.
• 17. Fang R, Cao B, Zhang Q, Li P, Zhang ST. The role of a transparent cap in the endoscopic removal of foreign bodies in the esophagus: A propensity score-matched analysis. J Dig Dis 2020;21:20-8.
• 18. Wahba M, Habib G, Mazny AE, et al. Cap-Assisted technique versus conventional methods for esophageal food bolus extraction: A comparative study. Clin Endosc 2019;52:458-63.
• 19. Hong KH, Kim YJ, Kim JH, et al. Risk factors for complications associated with upper gastrointestinal foreign bodies. World J Gastroenterol 2015;21:8125-31.
• 20. Wu WT, Chiu CT, Kuo CJ, et al. Endoscopic management of suspected esophageal foreign body in adults. Dis Esophagus 2011;24:131-7.