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Eur J Cardiothorac Surg 2002;22:486-487
© 2002 Elsevier Science NL

Letter to the Editor

Esophageal foreign bodies

Department of Surgery, M580 Health Sciences Center, University of Missouri–Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA

Received 25 April 2002; accepted 5 June 2002.

* Corresponding author. Tel.: +1-573-882-4158; fax: +1-573-884-4585
e-mail: jonesjw{at}health.missouri.edu

We read with interest the recent article by Athanassiadi et al. on management of esophageal foreign bodies (FBs) [1]. The study retrospectively analyzes 400 cases managed over a 35-year period, with remarkably low complication rates in esophagoscopic (0.25%) FB removal [1].

Although Athanassiadi et al. note that most of their patients had difficulty swallowing, acute pain, dysphagia, excessive salivation and other symptoms characteristic of FB ingestion [1], the authors did not further analyze the associated predictive variables. The variables' correlation with the FB findings at endoscopy constitutes important clinical information. To our knowledge, only one recent study, not cited in this article, attempted to prospectively determine predictive parameters for endoscopic FB findings [2]. Immediate onset of symptoms, dysphagia, and absent pharynx localization of impaction were statistically predictive of positive endoscopic findings, with diagnostic sensitivity of 86% and specificity of 63% [2]. The benefit of analyzing these predictive variables is twofold, the first of which is more efficient anamnesis. Second, it can influence the costs associated with esophageal FB management. A recent cost analysis study of various esophageal FB management policies concluded that the expense of endoscopy is significantly greater than that of other removal methods without equivalent added benefit [3].

Athanassiadi et al.'s study leaves an impression that X-ray diagnosis is essential, based on the zero false-negative results and contrast-related complications [1]. The authors do not cite other studies that support a decision to endoscope based on clinical impressions [2,4]. X-Ray establishes the esophageal perforation diagnosis in only 85% of patients [5].

As Athanassiadi et al. conclude, rigid endoscopy is safe and effective in experienced hands [1], but most gastrointestinal endoscopists of this generation are not trained to remove FBs with rigid endoscopes. Otolaryngologists who are routinely trained to use rigid scopes are probably the best consultants in such cases, but more widespread use of flexible scopes by gastrointestinal endoscopists can be safe and cost-effective. Athanassiadi et al.'s study is valuable, calling upon a 35-year experience, to establish management guidelines for a variety of FBs appearing throughout the esophagus.

References

1. Athanassiadi K., Gerazounis M., Metaxas E., Kalantzi N. Management of esophageal foreign bodies: a retrospective review of 400 cases. Eur J Cardiothorac Surg 2002;21:653-656.[Abstract/Free Full Text]
2. Ciriza C., GarcÍa L., Suárez P., Jiménez C., Romero M.J., Urquiza O., Dajil S. What predictive parameters best indicate the need for emergent gastrointestinal endoscopy after foreign body ingestion?. J Clin Gastroenterol 2000;31:23-28.[Medline]
3. Calkins C.M., Christians K.K., Sell L.L. Cost analysis in the management of esophageal coins: endoscopy versus bougienage. J Pediatr Surg 1999;34:412-414.[Medline]
4. Marais J., Mitchell R., Wightman A.J. The value of radiographic assessment for oropharyngeal foreign bodies. J Laryngol Otol 1995;109:452-454.[Medline]
5. Mizutani K., Makuuchi H., Tajima T., Mitomi T. The diagnosis and treatment of esophageal perforations resulting from nonmalignant causes. Surg Today 1997;27:793-800.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James W. Jones Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Losanoff, J. E. Articles by Jones, J. W. Search for Related Content PubMed PubMed Citation Articles by Losanoff, J. E. Articles by Jones, J. W. Related Collections Esophagus - other