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Endoscopic foreign body removal in the upper gastrointestinal tract: risk factors predicting conversion to surgery



Most foreign bodies of the upper gastrointestinal tract (UGIT) are successfully removed by endoscopic techniques without complications. However, some require conversion to surgery due to failure of endoscopic removal. The aim of this study was to analyze the risk factors predicting the need to convert to surgery after inability to endoscopically remove the foreign body.

Patients and methods

The medical records of 885 patients treated between January 2006 and March 2014 for suspected foreign bodies in the UGIT were retrospectively reviewed. Patient characteristics, the type of foreign bodies, clinical outcomes, and risk factors predicting the conversion to surgery were analyzed.


While endoscopic removal was successful in 94.7 % (665/702) of the patients, the remaining 5.3 % (37/702) needed conversion to surgery. There were no procedure-related deaths. According to the multivariate logistic regression analyses, older age (>70 years, p = 0.004), location (upper esophagus, p = 0.001), larger size (maximal diameter > 30 mm, p = 0.005), and longer impaction time (>40 h, p < 0.001) were significant risk factors predicting conversion to surgery due to inability to remove the foreign body endoscopically.


Most of the foreign bodies in the UGIT were successfully removed by endoscopic techniques. However, surgical removal might need to be considered in patients with age >70 years, and those with foreign bodies in the upper esophagus, maximal diameter >30 mm, and impaction time >40 h, due to the possible high failure rate of endoscopic removal.

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  1. 1.

    Ginsberg GG (1995) Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 41(1):33–38

  2. 2.

    Lyons MF 2nd, Tsuchida AM (1993) Foreign bodies of the gastrointestinal tract. Med Clin N Am 77:1101–1114

  3. 3.

    Stack LB, Munter DW (1996) Foreign bodies in the gastrointestinal tract. Emerg Med Clin N Am 14:493–521

  4. 4.

    Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Decker GA, Fanelli RD, Fisher LR, Fukami N, Harrison ME, Jain R, Khan KM, Krinsky ML, Maple JT, Sharaf R, Strohmeyer L, Dominitz JA (2011) Management of ingested foreign bodies and food impactions. Gastrointest Endosc 73(6):1085–1091. doi:10.1016/j.gie.2010.11.010

  5. 5.

    Loh KS, Tan LK, Smith JD, Yeoh KH, Dong F (2000) Complications of foreign bodies in the esophagus. Otolaryngol Head Neck Surg 123(5):613–616. doi:10.1067/mhn.2000.110616

  6. 6.

    Smith MT, Wong RK (2007) Foreign bodies. Gastrointest Endosc Clin N Am 17(2):361–382. doi:10.1016/j.giec.2007.03.002

  7. 7.

    Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L (2009) Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc 69(3 Pt 1):426–433. doi:10.1016/j.gie.2008.05.072

  8. 8.

    Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J (2002) Guideline for the management of ingested foreign bodies. Gastrointest Endosc 55(7):802–806

  9. 9.

    Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z (2006) Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China. Gastrointest Endosc 64(4):485–492. doi:10.1016/j.gie.2006.01.059

  10. 10.

    Park YK, Kim KO, Yang JH, Lee SH, Jang BI (2013) Factors associated with development of complications after endoscopic foreign body removal. Saudi J Gastroenterol 19(5):230–234. doi:10.4103/1319-3767.118136

  11. 11.

    Ambe P, Weber SA, Schauer M, Knoefel WT (2012) Swallowed foreign bodies in adults. Deutsch Arztebl Int 109(50):869–875. doi:10.3238/arztebl.2012.0869

  12. 12.

    Webb WA (1995) Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 41(1):39–51

  13. 13.

    Vizcarrondo FJ, Brady PG, Nord HJ (1983) Foreign bodies of the upper gastrointestinal tract. Gastrointest Endosc 29(3):208–210

  14. 14.

    Mosca S, Manes G, Martino R, Amitrano L, Bottino V, Bove A, Camera A, De Nucci C, Di Costanzo G, Guardascione M, Lampasi F, Picascia S, Picciotto FP, Riccio E, Rocco VP, Uomo G, Balzano A (2001) Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy 33(8):692–696. doi:10.1055/s-2001-16212

  15. 15.

    Lai AT, Chow TL, Lee DT, Kwok SP (2003) Risk factors predicting the development of complications after foreign body ingestion. Br J Surg 90(12):1531–1535. doi:10.1002/bjs.4356

  16. 16.

    Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT (1996) Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 20(8):1001–1005

  17. 17.

    Nandi P, Ong GB (1978) Foreign body in the oesophagus: review of 2394 cases. Br J Surg 65(1):5–9

  18. 18.

    Chaikhouni A, Kratz JM, Crawford FA (1985) Foreign bodies of the esophagus. Am Surg 51(4):173–179

  19. 19.

    Berggreen PJ, Harrison E, Sanowski RA, Ingebo K, Noland B, Zierer S (1993) Techniques and complications of esophageal foreign body extraction in children and adults. Gastrointest Endosc 39(5):626–630

  20. 20.

    Kerschner JE, Beste DJ, Conley SF, Kenna MA, Lee D (2001) Mediastinitis associated with foreign body erosion of the esophagus in children. Int J Pediatr Otorhinolaryngol 59(2):89–97

  21. 21.

    Silva RG, Ahluwalia JP (2005) Asymptomatic esophageal perforation after foreign body ingestion. Gastrointest Endosc 61(4):615–619

  22. 22.

    Chauvin A, Viala J, Marteau P, Hermann P, Dray X (2013) Management and endoscopic techniques for digestive foreign body and food bolus impaction. Dig Liver Dis 45(7):529–542. doi:10.1016/j.dld.2012.11.002

  23. 23.

    Sung SH, Jeon SW, Son HS, Kim SK, Jung MK, Cho CM, Tak WY, Kweon YO (2011) Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis 43(8):632–635. doi:10.1016/j.dld.2011.02.018

  24. 24.

    Park JH, Park CH, Lee SJ, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ (2004) Review of 209 cases of foreign bodies in the upper gastrointestinal tract and clinical factors for successful endoscopic removal. Korean J Gastroenterol = Taehan Sohwagi Hakhoe chi 43(4):226–233

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Ho-Jun Lee, Hyun-Soo Kim, Jin Jeon, Sang-Hun Park, Sung-Uk Lim, Chung-Hwan Jun, Seon-Young Park, Chang-Hwan Park, Sung-Kyu Choi, Jong-Sun Rew have no conflict of interest or financial ties to disclose.

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Correspondence to Hyun-Soo Kim.

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Lee, H., Kim, H., Jeon, J. et al. Endoscopic foreign body removal in the upper gastrointestinal tract: risk factors predicting conversion to surgery. Surg Endosc 30, 106–113 (2016).

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  • Digestive
  • G-I < endoscopy
  • Technical < endoscopy