Foreign body ingestion: understanding the implications

• Published in: Frontline gastroenterology 2022-03, Vol.13 (2), p.94-95
• Main Authors: Henderson, Max, Everett, Simon M
• Format: Article
• Language: English
• Subjects: Commentary; endoscopic procedures; Endoscopy; Foreign bodies; Gastroenterology; Learning disabilities; Mental disorders; Patients; Professionals; Psychiatry; Self destructive behavior; Suicides & suicide attempts
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2021-101847

In this edition of Frontline, Yadollahi et al report on a large series of such patients in their tertiary referral centre in Southampton.1 The authors describe an increasing incidence of foreign body ingestions over a 5-year period, discuss the outcomes of endoscopic management and relate the anticipated burden of this increasing presentation on staff and resources in their hospital. [...]a view feels uncomfortably like the withholding of appropriate analgesia when suturing patients who have self-harmed and would be nothing less than punishment if pursued as policy.4 Such opinions should not deter from a discussion about appropriate timing for endoscopy in these patients, but this should be predicated simply on an evaluation of the evidence for clinical harm from delay versus the demands of urgent or emergency endoscopy on already busy units. [...]to the European Society of Gastrointestinal Endoscopy recommendation for emergency (preferably within 2 hours) endoscopy for foreign bodies inducing complete oesophageal obstruction and for sharp-pointed objects or batteries in the oesophagus, the authors report a median time to extraction of 6 hours (range 3–18 hours) for such patients with no major consequences.5 These data suggest that while such objects should be removed quickly, the timing of the procedure requires a careful individual balance of risks and benefits and that, while caution should be the first priority, performing the procedure first thing the next day may be appropriate in carefully selected cases.