Eur J Cardiothorac Surg 2002;22:487-488
© 2002 Elsevier Science NL
Reply to Losanoff et al.
Kalliopi Athanassiadi*,
M. Gerazounis
Department of Thoracic Surgery, General Hospital of Piraeus, Athens, Greece
Received 3 June 2002;
accepted 5 June 2002.
* Corresponding author. Nikea General Hospital, 34A Konstantinoupoleos Str., 15562 Holargos, Athens, Greece. Tel.: +30-1-6510388; fax: +30-1-6547695
e-mail: kallatha{at}otenet.gr
We appreciate the comments by Losanoff et al. Concerning the predictive parameters in the study of Ciriza et al. [1] that you mentioned, the authors were not able to locate the foreign body (FB) in 48% of their cases, whereas we did not locate a FB only in 10%. So, probably they overestimated the subjective symptoms of their patients such as dysphagia or pain, did not estimate the clinical picture and proceeded urgently to endoscopy without further consideration. The degree of urgency and the timing of endoscopy do not depend only on the symptoms but mainly on the increased risk of perforation, aspiration or aortoesophageal fistula [2,3]. For instance, sharp objects or batteries require urgent intervention, since the complication rate can be as high as 35% [2,3].
Chest X-ray was usually performed in our series but we stressed that barium study (esophagography) turned out to be a very useful tool with no false negative results. In the study you mentioned by Marais et al. [4] the authors came to the same conclusion, that esophagography had a 100% diagnostic accuracy.
Finally, you comment that according to Calkins et al. [5] the method of bougienage used only for coins extraction in children was found to be cost-effective compared to endoscopy. All alternative therapeutic methods already mentioned in our study turned out to be less expensive than endoscopy. Their disadvantages are that all of them are blind methods of extraction providing no control of the FB as it is removed. They can only be used for blunt FBs of short duration and with no preexisting esophageal disease [2,3]. We do support the authors opinion that flexible endoscopy is cost-effective since it is performed on an outpatient basis without general anesthesia, but on the other hand, when sharp or penetrating FBs are in question, rigid endoscopy is required, because it allows the security of the airway and removal of most objects under direct vision without withdrawing the endoscope [2,3]. At last, otolaryngologists are generally keen in using rigid scopes in the upper respiratory tract but have no experience of the esophagus.
References
- 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]
- Webb W.A. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995;41:39-50.[Medline]
- Ginsberg G.G. Management of ingested foreign bodies and food bolus impactions. Gastrointest Endosc 1995;41:33-38.[Medline]
- Marais J., Mitchell R., Wightman A.J. The value of radiographic assessment for oropharyngeal foreign bodies. J Laryngol Otol 1995;109:452-454.[Medline]
- 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]
